Is a Doctor Referral Really in Your Best Interest?

Rachel Morrell

Patient gets doctor referral

You may have noticed that hospital systems are taking ownership of medical offices and healthcare facilities in your community. What you may not have recognized is how those takeovers are affecting your wallet. Learn how to take back control of your healthcare (and your budget) when your doctor offers you a referral.

A Doctor Referral is Just a Referral

If you are like most people, you probably follow your doctor’s recommendations when it comes to referrals. First, your doctor hands you a card with the contact information of the specialist. Then, you call to make an appointment, or your primary care office is kind enough to make an appointment for you.

That courtesy and convenience may cost you hundreds of hard-earned dollars. According to The Wall Street Journal article, “The Hidden System That Explains How Your Doctor Makes Referrals,” many doctors employed by hospital systems feel pressured to refer patients to other physicians in their hospital system, even if the patient may benefit more from a physician outside the system. Often, doctors don’t offer an explanation for why they have recommended a certain physician or facility, and patients rarely ask. But, as the patient, you can and should ask. A doctor referral is just that – a referral, not a requirement.

Because many primary care physicians work at hospital-owned practices, they are expected to refer patients to physicians within their hospital group. These in-house doctor referrals often mean patients will be scheduling their procedures at hospitals or hospital outpatient departments (HOPD), which may be much more expensive than at freestanding ambulatory surgery centers (ASC).

Take Control of Your Healthcare Decisions

Regardless of whether you have insurance or are paying out of pocket, you have options when it comes to your healthcare. You can shop for your healthcare in the same way you shop for an appliance or a select piece of furniture. For example, when your primary care doctor recommends you schedule a colonoscopy and makes a referral, ask why he or she prefers that physician or facility and request an estimate of the costs.

Ask your doctor for the procedure code if you are investigating a service like a colonoscopy or cataract surgery. You will need this code to compare specialists and facilities. Next, call your insurance company for details about your benefits and ask for a list of in-network physicians and facilities. Then, begin your search.

You can also ask friends and family members for recommendations or read online reviews and testimonials. Call around and ask for pricing from various local medical specialists or facilities or visit sites that make price comparison easy, such as HealthcareBluebook.com and Medicare.gov Procedure Price Lookup Tool (for Medicare patients).

Location, Location, Location

If you need a medical procedure that does not require an overnight stay at a hospital, compare pricing at an ASC versus a HOPD. For example, the average cost of a colonoscopy is $1,711 at an independent ASC compared to $2,750 at a hospital-owned facility. Scheduling your procedure at an independent ASC could save you as much as 40 percent.

Besides being more affordable, ASCs offer advantages including:

  • Transparent pricing
  • Curbside drop off and pick up
  • Convenient parking
  • Shorter wait time
  • Top-ranked industry accreditations and certifications for safety and quality

Save on Your Next GI Procedure

If you need to schedule a healthcare procedure, remember these facts that can save you money:

  • You have a choice outside of your doctor referral, so be bold and ask about pricing
  • With a little background knowledge, you can comparison shop for high-quality procedures at an affordable price

Do you need a colonoscopy or outpatient GI procedure? Click here or call 877.706.SCCN (7226) for a list of ASCs in your area.

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