In 2010, visits to medical specialists (not including pediatricians and obstetricians/gynecologists) accounted for 44.8 of medical visits, up from 33.8 percent in 1980. So despite managed care, we’re using medical specialists more than ever. And that adds to medical costs.
Seeing a specialist costs more than seeing a primary care physician. A specialist also does not know your entire medical history like your primary care physician does. The following tips can help make that visit worth your time and money.
Before making an appointment, review your coverage. Some plans require a primary care provider’s referral.
Planning Your Visit
What is the purpose of your visit? If your primary care physician refers you to a specialist, ask why. Does he/she want the specialist to confirm or make a diagnosis, put together a treatment plan or provide a service (such as surgery) that your primary care physician doesn’t provide? Knowing the goal of your visit can help keep you and your providers on track.
What level of care do you need? Some specialists have very narrowly focused practices. For example, oncologists treat cancer patients, but some oncologists treat children only, while others focus on gynecological cancers. Do you need the expertise of a specialist with a highly focused practice, or will one with a more general practice do? Usually the more specialized the practice, the longer you will wait for appointments and the more you will pay for care.
Which specialist will you see? Your primary care physician will likely give you the name of a colleague or two. But ultimately, it’s your decision because you are responsible for the quality of healthcare you receive. A physician can “specialize” in any field of medicine regardless of whether he/she has received advanced training. To check whether a physician has completed an approved residency program and passed an exam in his/ her specialty area, check the listings at the American Board of Medical Specialties, www. abms.org. The Medicare Physician Compare site provides performance information on physicians and other healthcare professionals. You can find physicians by geographic location and specialty at www.medicare.gov/physiciancompare/search.html.
What does your insurance require? Before making an appointment, review your coverage. Some plans require a primary care provider’s referral and/or preauthorization before it will pay for a visit to a specialist. Check to see what type of documentation your plan requires and follow requirements to the letter to avoid claim disputes.
Have you selected an in-network provider? Check your plan’s preferred provider list. Choosing an out-of-network provider can add hundreds or even thousands of dollars to your out-of-pocket costs.
When will you see the specialist? If time is critical, ask your primary care provider’s office to request an appointment for you.
What information will your primary care provider give the specialist? Before the appointment, ensure your primary care provider communicates the reason for the referral and provides your medical history and relevant test or imaging results.
What medications do you take? Before your visit, list all medications you take, including dosages and frequency. Don’t forget over-the-counter medications, vitamins, supplements and herbs, as many of these interact or interfere with other drugs.
At Your Visit
What will you discuss? To start, ask your specialist if he/she knows the reason for the referral and whether your primary care physician has provided all relevant records. After a review of your records and an examination, you will want to discuss your treatment plan. What are the potential side effects or complications and how likely are they? How will your condition and any recommended treatments affect your general health and quality of life? Feel free to discuss, or even debate, your treatment plan. If you have concerns, you can always ask for a second opinion. Depending on your situation, you might also want to discuss preventive or self-care. Are there things you can do to improve your condition or prevent it from worsening?
Will you see the specialist again? If your treatment plan includes surgery, will the specialist provide follow-up care, or will your primary care physician? Will you visit the specialist on an ongoing basis, or will your primary care physician manage your treatment?
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