“Open referral” – what does this mean for you, the patient?

When you go to your GP and he or she recommends an investigation or treatment you will be referred to a specialist.  Under “open referral” (as is currently practised by some insurers) it’s possible that neither the specialist nor the treating hospital will be named.  Your insurance company may, if it accepts that the procedure is covered by your policy, decide to whom you are referred and where.

This could have several possible effects:

  • you may find that a condition for which you have had treatment previously is now being dealt with by a different doctor in a different hospital
  • you may find that the doctor and the hospital are farther away from either your home or your workplace
  • you may find that the doctor is less experienced in your condition – possibly a ‘generalist’ rather than a specialist in your condition
  • you may find that the costs of treatment are lower and that you avoid any surcharges associated with higher consultant fees.

The important issues for us a the Private Patients’ Forum is first that you know exactly what the implications of “open referral” are and that you do not discover that your policy – or, more likely, the policy your employer has provided on your behalf – has changed without your knowing. That change will interfere with your ability to make choices.  Choice was, after all, one of the main reasons you and/or your employer decided to opt for private healthcare.  You can see some more thoughts on Open Referral from one of PPF’s experts by clicking here.

If you have any experience of “open referral”, please contact us and tell us what happened – we want to help other patients by sharing knowledge.

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