How do you explain referrals to patients and their families?

1 Why referrals are needed

Referrals are when your primary care provider (PCP) sends you to see another health professional, such as a specialist, therapist, or diagnostician, for further evaluation or treatment. Referrals are needed when your PCP cannot address your health issue or concern adequately, or when you need a specific service or procedure that your PCP cannot provide. Referrals can help you get the best possible care for your condition and avoid unnecessary complications or delays.

2 How referrals work

The referral process may differ depending on your health plan, provider network, and location, but generally it involves the following: Your PCP determines that you need a referral and discusses it with you, then contacts the referral provider or facility to request an appointment for you, sending them your relevant medical information and records. The referral provider or facility will confirm the appointment and notify both you and your PCP of the details. You will attend the visit and receive the service or procedure that you need, after which the provider or facility sends a report of the visit and results to your PCP. Finally, your PCP will follow up with you and the referral provider or facility to review the report and discuss further steps for your care.

3 How to prepare for referrals

Before scheduling a referral visit, it's important to ask your primary care provider (PCP) why you need a referral, what the referral provider or facility will do, and how it will affect your care plan. Research the referral provider or facility and their credentials, reputation, and location. Additionally, make sure to check if they are in your health plan's network and if you need any prior authorization or co-payment. Write down any questions or concerns that you have for the referral provider or facility, such as what the risks and benefits of the service or procedure are, what the alternatives are, and what the follow-up plan is. When attending the appointment, bring your identification, insurance card, medication list, and any other relevant documents or information. You can also bring a family member or friend for support or assistance if needed.

4 How to communicate with referrals

Communication is essential for a successful and positive referral experience. It's important to be honest and respectful about your health history, symptoms, goals, and preferences. Make sure to share any information that may affect your care or outcome, such as allergies, chronic conditions, or lifestyle factors. Listen actively and attentively to the referral provider or facility and don't hesitate to ask for clarification or repetition if something is unclear. Express any questions or concerns that you have clearly and politely, and consider asking for a second opinion or a different option if you are not comfortable or satisfied with the service or procedure offered. Finally, follow the instructions and recommendations that the referral provider or facility gives you. If there are any problems or issues with the service or procedure, contact them or your PCP as soon as possible.

5 How to coordinate referrals

Referrals can be a complex and daunting process, but they can also be a valuable and beneficial part of your health care. To coordinate your referrals effectively, you should keep a record of them, including names, contact information, dates, and outcomes. You can also use a calendar, planner, or app to organize your appointments and reminders. Additionally, it's important to communicate regularly with your PCP and the referral provider or facility. Share any changes in your health status, medication, or treatment with them. Request copies of your reports, results, and records as well, and make sure to advocate for your needs and preferences if any barriers or difficulties arise. By understanding, preparing, communicating, and coordinating your referrals in this way, you can make the most of the experience and improve your health outcomes.

6 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?