Referrals and specialists

If you need specialist care, your GP will usually write you a referral. A referral shares information with the specialist and, for Medicare purposes, means you can claim Medicare benefits for the specialist's services. This guide summarises how referrals work, based on Services Australia information. Rules can change, so check the official pages.

This is general information, not medical or financial advice.

Why referrals matter

According to Services Australia, to get Medicare benefits for specialist services you generally need a valid referral. Without one, you may still be able to see the specialist, but you might not be able to claim Medicare benefits.

A referral also gives the specialist information about your health and the reason you're being referred, which helps them prepare.

How long referrals last

Services Australia says:

• referrals from a GP are generally valid for 12 months from the first specialist service, unless the GP specifies a different period, which can be shorter, longer or indefinite;
• referrals from one specialist to another are generally valid for 3 months, unless the referred patient is admitted to hospital.

If your referral has expired, you'll usually need a new one to claim Medicare benefits. Check the date on your referral, and ask your GP if you're not sure.

Choosing a specialist

When your GP suggests a referral, you can ask:

• Which specialist do you recommend and why?
• Are there other options, including public hospital clinics?
• What are the likely waiting times?
• What are the likely costs?

Your GP can write a referral to a named specialist or, in some cases, a general referral. Ask your GP what suits your situation.

Asking about costs

Specialist fees vary. Ask the specialist's rooms about fees and Medicare rebates before your appointment. See asking about fees.

Preparing for the specialist

• Take the referral (or check it's been sent).
• Bring your Medicare card, list of medicines, and any results or scans.
• Write down your questions.

Our visit planner can help.

After the specialist

The specialist usually writes to your GP with findings and recommendations. Book a follow-up with your GP to discuss the plan.

Waiting times and public options

Waiting times to see specialists vary widely by specialty, location and urgency. Public hospital outpatient clinics may see patients at no cost, but often have longer waits for non-urgent conditions. Private specialists may see you sooner, but usually charge fees above the Medicare benefit. If your condition gets worse while you're waiting, go back to your GP, who may be able to ask for an earlier appointment. Ask your GP which option makes sense for your situation.

Living in a rural or remote area

Access to health care can be harder outside cities. Waiting times may be longer, distances greater and services fewer. Some things that can help:

• plan routine appointments well ahead and book follow-ups before you leave;
• ask whether telehealth is available for suitable appointments;
• check whether your area has visiting specialists, outreach clinics or a Royal Flying Doctor Service clinic;
• ask about patient travel assistance schemes, which state and territory governments run to help with the cost of travelling long distances for specialist care.

In an emergency, wherever you are, call Triple Zero (000).

Keeping track of your own health information

It's useful to keep your own record of key health information: your conditions, medicines, allergies, vaccinations, test results and the names of your GP and specialists. You can keep a paper folder, a note on your phone, or use My Health Record, the Australian Government's online summary of your health information. My Health Record can hold information such as prescription and dispensing records, pathology and imaging reports, and hospital discharge summaries, depending on what your health providers upload. You can access it through myGov and control some privacy settings. Having this information to hand makes appointments, and especially appointments with new providers, much smoother.

A quick checklist before you go

• Do I know the date, time, address and how to get there (or the link for telehealth)?
• Do I know whether it will be bulk billed or what the fee will be?
• Do I have my Medicare card and any concession card?
• Have I written a list of my medicines and my questions?
• Do I have any referral, results or letters I need?
• Do I need an interpreter, a support person or accessibility arrangements?

Our visit planner builds a printable version of this list.

Practical ways to manage health costs

• Ask about bulk billing and fees before every new service.
• Keep receipts and check your Medicare claims, which you can see in your Medicare online account.
• If you or your family have high out-of-pocket costs for Medicare services in a calendar year, look into the Medicare Safety Net, which may increase the benefit you get back once you reach a threshold. Families and couples need to register as a family to combine their costs. Check Services Australia for current details.
• If you hold a concession card, mention it, because some practices bulk bill concession card holders.
• Ask your GP whether generic medicines are suitable, and talk to your pharmacist about medicine costs and the PBS Safety Net.

If you need an interpreter

If English isn't your first language, you can ask for an interpreter. The Translating and Interpreting Service (TIS National), run by the Australian Government, provides interpreting, and many GPs and specialists can use it for free for eligible consultations. Tell the practice when you book so it can arrange an interpreter by phone or, sometimes, in person. Using a professional interpreter, rather than a family member, helps make sure medical information is passed on accurately and privately. If you're deaf or have a hearing or speech impairment, ask about the National Relay Service or Auslan interpreting.

What a referral contains

A referral is usually a letter from your GP to the specialist. It typically includes your details, the reason for the referral, relevant history, medicines and test results, and the date. If a referral period other than the standard one applies, the GP notes it. Many referrals are now sent electronically, so ask whether you need to take a copy. Check that the specialist's rooms have received it before your appointment.

Tips for older people

If you're older or have several health conditions, appointments can involve a lot of information. Consider:

• booking a longer appointment so there's time to cover everything;
• asking your GP about a medication review, especially if you take several medicines;
• asking about health assessments that may be available for older people;
• bringing a family member or friend for support;
• asking for written information you can read later.

If getting to the practice is hard, ask about telehealth, home visits or community transport options in your area.

How we keep this guide up to date

Medicare rules, government programs and service arrangements change from time to time. We review this guide against the official sources listed below and update the date at the top of the page when we check it. If something has changed, or you spot an error, please let us know through our contact page. Before you rely on any detail, especially eligibility rules, check the official page linked in the sources, or ask your practice or Services Australia directly.

Use the visit planner

Our free visit planner turns this advice into a short, printable list. Choose the kind of appointment, add your own questions, and it lists what to bring and what to ask, always including a question about billing. Everything stays in your browser and nothing is sent to us. It's a planning aid only, not medical advice.

Key points

• You generally need a valid referral to claim Medicare benefits for specialist services.
• GP referrals are generally valid for 12 months from the first specialist service, unless the GP specifies otherwise.
• Specialist-to-specialist referrals are generally valid for 3 months.
• Ask about options, waiting times and costs.
• Medicare Urgent Care Clinics don't need a referral.