Referrals

Why do you need a referral at Roka Foot and Ankle Centers?

Healthcare can be difficult to navigate and understand. One of the common questions that Dr. Buckley and her staff are asked is "why do I need a referral?". 

Dr. Buckley is a specialist. Podiatry; Foot and Ankle care is a specialty.

What is a referral:

"A referral is a formal request from one healthcare provider (usually your primary care physician, or PCP), recommending that you see a referral specialist for more advanced care. Referrals are often necessary for insurance purposes, especially if you’re part of a managed care plan like an HMO.  Also, as of recent years, I am seeing more insurance companies requesting a referral for PPO and Medicare Advantage plans.

How do referrals work: 

The referral is when your PCP evaluates your condition and determines that a specialist’s expertise is needed. Your PCP will issue a doctor’s referral letter or complete an electronic referral call or submission within your insurer’s network. 

Your PCP sends this request to the specialist with your medical history and the reason for the referral. The specialist than schedules the appointment once the referral is approved. 

Can I See a Specialist Without a Referral? 

Yes, you absolutely can but do so with caution. 

With some PPO plan, you may not need a referral, but lately, more insurance companies are demanding a referral especially with certain PPO insurance plans.  Referrals are necessary if you participate an HMO, Medicare, Medicare Advantage or Medicaid plan, skipping the referral can result in out-of-pocket expenses or a denied insurance claim. 

Also, can urgent care refer you to a specialist? 

Yes, urgent care centers can initiate referrals, especially if immediate specialist care is necessary.  

Why Referrals Matter 

Referral in healthcare aren’t just red tape—they are tools that: 

• Ensure you receive the appropriate care 
• Help control healthcare costs 
• Improve communication between providers 
• Protect your insurance benefits 

Incorrect or missing referrals can lead to delays in treatment, higher costs, or even coverage denial.