What Is a Medical Referral and How Does It Work in Australia?
A medical referral is a written communication from one healthcare professional to another health professional or service. It explains why further assessment or care is being requested and provides relevant clinical information.
In Australia, referrals are especially important when seeing a medical specialist because a valid referral is generally required for Medicare benefits to apply to specialist consultations. Referral rules vary depending on the type of service, who makes the referral and the reason for it.
Key takeaways
• A referral helps another healthcare professional understand why you are being sent to them and provides relevant clinical information.
• You generally need a valid referral to claim Medicare benefits for a consultation with a medical specialist or consultant physician.
• Most GP referrals to specialists are valid for 12 months from the date of your first specialist appointment, unless the referral states another period.
• A specialist-to-specialist referral is generally valid for 3 months, with different rules for admitted patients.
• You can be involved in choosing which specialist you see and, in many cases, a referral does not need to name a specific specialist.
• A referral is different from a request for pathology or diagnostic imaging, even though the terms are sometimes used interchangeably.
What is a medical referral?
Healthdirect describes a referral as a letter from a doctor or other health professional to another health professional or health service. It is used when another clinician or service is needed for further assessment, advice or care.
A referral will usually include information such as:
• the reason for the referral
• relevant information about your current health issue
• important medical history or test results where relevant
• the date of the referral
• the referring practitioner’s details and signature or valid digital authentication
The information included should be relevant to the reason you are being referred. The receiving practitioner may also ask you questions or request additional records when they assess you.
When do you need a referral?
Whether you need a referral depends on the healthcare service. You do not generally need a referral simply to make an appointment with a GP, but referrals are commonly used when moving from general practice to specialist care or to certain Medicare-funded allied health services.
For specialist medical care, Services Australia sets out referral requirements that allow eligible specialist and consultant physician services to be billed as referred services under Medicare.
Other programs, including some allied health and mental health services, have their own referral or care-plan requirements. The healthcare service can tell you what is needed when you book.
Do I need a referral to see a specialist?
For Medicare purposes, you generally need a valid referral to receive Medicare benefits for a consultation with a medical specialist or consultant physician.
Some specialists may agree to see a patient without a referral, but Medicare benefits generally will not apply to an unreferred specialist consultation. It is therefore worth checking both the referral requirement and the specialist’s fees before booking.
For more on Medicare and healthcare costs, read Is Telehealth Covered by Medicare in Australia?.
How long does a specialist referral last?
A standard GP referral to a specialist is generally valid for 12 months unless the referring GP specifies a different period.
Importantly, Services Australia says the 12-month period begins from the specialist’s first service under the referral, not from the date the GP wrote the referral.
A GP can write a referral for more or less than 12 months, or make it indefinite, when clinically appropriate. If a new or unrelated health issue develops, a new referral may still be required even if an indefinite referral is in place.
Referrals from one specialist or consultant physician to another are generally valid for 3 months. Different rules apply to referrals made for admitted hospital patients.
Does the referral need to name a particular specialist?
Not always. A referral can be written to a particular specialist, or it can be an open referral to a specialist in the relevant field.
Australian Government guidance on choosing a medical specialist encourages patients to be involved in the decision and notes that open, named and multiple-named referrals are possible.
When choosing a specialist, you may want to consider:
• the specialist’s field of practice and experience relevant to your needs
• location and accessibility
• waiting times
• consultation and procedure fees
• whether the specialist participates in any relevant no-gap or known-gap arrangements for hospital care
• whether you feel comfortable with the practitioner’s communication style
If you want to check a practitioner’s registration, see How to Check if a Healthcare Practitioner Is Registered in Australia.
Can I take a named referral to another specialist?
In many cases, yes. Australian Government patient guidance says a named referral can be taken to another doctor practising in the same specialty.
However, specialist practices can have their own administrative requirements, and a particular specialist may choose which referral formats they accept. If you want to change specialists, contact the new practice before your appointment and confirm that your existing referral can be used.
It is also helpful to let your regular GP know which specialist you ultimately see so your care can remain coordinated.
What is the difference between a referral and a request?
The words referral and request are often used casually as though they mean the same thing, but Medicare rules distinguish between them.
Services Australia explains that referrals apply to specialist, consultant physician and certain allied health services, while requests are used for tests such as diagnostic imaging and pathology.
For example:
• A GP referring you to a cardiologist is a referral.
• A clinician ordering a blood test is generally making a pathology request.
• A clinician ordering an X-ray or other diagnostic imaging is generally making an imaging request.
The rules around validity are also different. For example, Services Australia states that diagnostic imaging requests do not expire under Medicare and remain valid until the requested service has been performed.
What is the difference between a referral and a health summary?
A referral and a health summary serve different purposes. A referral formally directs or introduces you to another practitioner or service and includes the reason for the referral. A health summary is a broader overview of important information in your medical history.
A health summary may include:
• current and past medical conditions
• current medicines
• allergies and adverse reactions
• important test results or investigations
• other relevant clinical information
A health summary can be useful to a new healthcare professional, but it does not automatically replace a valid referral when Medicare or a particular service requires one.
Can a referral be electronic?
Yes. Referrals can be created and sent electronically when the relevant requirements are met and the receiving provider accepts that format.
Services Australia allows electronic referrals and requests where the system securely links the referring practitioner’s identity to the document or securely transmits it, and the referral can be retained and retrieved unaltered.
Depending on the service, you may receive a copy yourself, or the referral may be sent directly to the receiving clinic.
Can I get a specialist referral through telehealth in Australia?
A healthcare practitioner may be able to arrange a referral after a telehealth consultation when they have enough information to make an appropriate clinical decision and the relevant referral requirements are met.
The Medical Board of Australia says practitioners providing telehealth should make sure patients understand the arrangements for receiving referrals and other clinical documentation, while continuously assessing whether telehealth is clinically appropriate or an in-person assessment is needed.
A referral is therefore not automatic simply because it is requested. The practitioner still needs to assess the situation and decide what is appropriate.
What happens after I get a referral?
The next steps are usually:
• Check the referral details and the type of specialist or service you have been referred to.
• Choose a suitable specialist or service if one has not already been selected.
• Contact the specialist or service to make an appointment.
• Ask about fees, Medicare rebates, expected out-of-pocket costs and waiting times before you book.
• Provide the referral to the receiving clinic in the format it requests.
• Keep your regular GP or referring practitioner informed about where you are receiving care.
Before the appointment, you may also find it useful to read What Information Should You Have Ready for a Doctor Appointment?.
What if my referral is lost?
If a written specialist referral is lost, stolen or destroyed, Medicare has limited provisions that may allow an initial attendance to proceed. Services Australia says a valid referral should then be obtained before subsequent specialist services are billed as referred services.
In practice, the simplest step is usually to contact the referring clinic or specialist practice as soon as you notice the referral is missing and ask what they need you to do.
Do I need a new referral for a second opinion?
You can ask for another medical opinion if you want one. Healthdirect notes that patients can ask their doctor for a referral to another specialist for a second opinion.
Whether your existing referral can be used will depend on the referral wording, the specialty and the receiving practice. If you are unsure, ask the new specialist’s office before booking.
Questions to ask before a specialist appointment
• Is my referral still valid for this appointment?
• Do you accept an open referral or a referral addressed to another specialist in the same field?
• What is the consultation fee?
• What Medicare rebate may apply?
• What is the expected out-of-pocket cost?
• Do I need to send the referral before the appointment?
• Should I bring any test results, scans or other records?
• How long is the current waiting time?
A referral helps connect different parts of your care
A referral is more than an administrative form. It helps pass relevant clinical information to another healthcare professional and supports coordination between the people involved in your care.
If you are unsure whether you need a referral, how long it is valid or whether a particular clinic will accept it, ask the referring practitioner or receiving service before your appointment.
Learn more about Grove Health
Ready to learn more? Grove Health provides telehealth consultations with Australian-registered healthcare practitioners. Learn how Grove Health works and what to expect from your consultation.
This article provides general educational information and is not a substitute for individual medical or Medicare advice. Referral requirements can vary by service and circumstances. Check with the relevant healthcare provider or Services Australia if you are unsure.
Sources
• Healthdirect — What is a referral?
• Services Australia — Referrals for specialist treatment
• Services Australia — Refer or request Medicare services
• Australian Government Medical Costs Finder — A guide for patients: choosing a specialist
• Medical Board of Australia — Telehealth consultations with patients