Should You See A Medical Specialist?

Sometimes a primary physician is unable to diagnose a certain ailment or set of symptoms. Should you see a specialist?

Getting quality medical care is a concern of most people. Often we choose a primary care physician and make appointments to see that doctor when we become ill or symptoms appear. A family practice doctor or general practitioner will oversee a person's general health and most likely be able to treat the majority of medical problems that may arise.

But sometimes our primary doctor is unable to interpret certain conditions or to manage a particular illness. Should you see a specialist or should you just wait it out? Here are some things to consider in making your decision:

1. You may need to ask for a referral. If your primary care doctor is not concerned about your symptoms, or feels you should wait for further developments, or simply prefers to continue monitoring you himself or herself, you may have to request a referral. Most specialists will not see you without a referral, so talk to your doctor about the advantages and disadvantages of getting a specialist's opinion on your situation.

2. Check your insurance coverage and requirements. Some insurance will pay for a visit to the specialist only under certain conditions. Other policies pay a certain percentage of the cost of a visit. But insurance companies often mandate that a referral to a specialist be submitted for their approval by the primary doctor before the insurance company will agree to pay for the specialist visit. Failure to comply with insurance regulations usually means they will not pay for your care by the specialist. Also check to see if related services are covered. For example, if you visit your primary doctor about a suspicious mole on your face, and the doctor refers you to a dermatologist, or "skin doctor," for further evaluation, be sure your insurance covers the skin doctor to whom you are referred. In addition, find out if the laboratory used by the dermatologist for mole biopsies is covered in your insurance plan. If not, you may have to pay the bill yourself or ask the dermatologist to use another lab service.

3. Go with your gut. If you feel strongly that a second opinion is needed, and from a specialist at that, it may be a good idea to get it checked out. Sometimes our so-called intuition is based on slight impressions or hard-to-define observations in a medical change or appearance of symptoms. If you feel uneasy about your primary doctor's diagnosis or decision to wait, ask for a referral; most doctors will provide one unless they have good reasons not to.

4. Determine in advance what you want from the specialist. Are you seeking a second opinion? Or do you want a more qualified opinion? Are you trying to contradict your primary physician or find support for his or her initial diagnosis? Know in advance why you feel contacting a specialist is important, and how he or she might help your medical condition.

Keep in mind that if you visit a specialist, you may have to undergo further testing and become responsible for the deductible portion of these expenses that is not covered by your insurance. However, don't let that keep you from asking for a referral to a qualified specialist if you have reason to believe that an expert opinion may make a difference to your medical condition.

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