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Old 27.08.2021, 16:14
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GP refusing to do a medical referral without the specialist name on it

I'm finding myself in a deadlock situation with regards to consultation with a medical specialist:

- My health insurance model is based upon agreement on the medical specialist (Assura Qualimed) which forces me to "discuss" with them the choice of specialist so they can propose me 2 or 3 names. For that, they need first a medical referral (Überweisung) saying that I need indeed to see a specialist (which comes to the usual GP model).

- After seeing my GP, he refuses to do any specialist referral if he's not sending it to a specific doctor with a name on it.

I know some countries where the GP usually gives you a referral document without a name on it saying "to whom it may concern" or "dear cardiologist colleague". The insurance company tells me that this is also done on CH while the Swiss GP says that in CH this is not done ("we're in ZH and here we don't do things like that!" ) and he needs someone to send it to.

I don't think I will get any good of this situation and I simply need to either change my insurance model or my GP (or, better, both of them). Out of curiosity, who's right? Is a referral document without a specialist name on it something you can get from your GP in CH?
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Old 27.08.2021, 16:24
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Re: GP refusing to do a medical referral without the specialist name on it

Ask your doctor to make the referral to his specific specialist. You now have your referral letter.

Then call your insurer saying you have the referral letter and see who they suggest. Maybe one of them is one your doctor refers to and if not then go to one they suggest with your doctor's letter. Just because he refers you to Dr. so and so does not mean you have to go to that one - you still have a free choice, or in your case your insurers choice!
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Old 27.08.2021, 16:39
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Re: GP refusing to do a medical referral without the specialist name on it

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Ask your doctor to make the referral to his specific specialist. You now have your referral letter.
He's not giving me any documents, he's sending them directly to his colleague doctor, hence the issue.
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Old 27.08.2021, 16:44
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Re: GP refusing to do a medical referral without the specialist name on it

Are you communicating with him in German? If not, can you ask someone for help to do that, or pay someone for linguistic support?
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Old 27.08.2021, 16:45
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Re: GP refusing to do a medical referral without the specialist name on it

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He's not giving me any documents, he's sending them directly to his colleague doctor, hence the issue.
Does he not give you a copy? Whenever I’ve had a GP referral to a specialist, he’s faxed it to the specialist but given me the hard copy to take away. And instructed me to make sure I take it to the appointment with the specialist.
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Old 27.08.2021, 17:21
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Re: GP refusing to do a medical referral without the specialist name on it

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He's not giving me any documents, he's sending them directly to his colleague doctor, hence the issue.
You have a right to all documents in your file. Just say you want a copy. End of story.
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Old 27.08.2021, 17:45
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Re: GP refusing to do a medical referral without the specialist name on it

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You have a right to all documents in your file. Just say you want a copy. End of story.
@macrol: The doc has an idea of how things are done, you have your own and they are different. So, avoid discussion which is not going nowhere. We have plenty of thread for that around EF

Snopy is right, no reason to put an effort arguing with the doc, get the copy with whichever name is there, bring this copy to other specialist and get this done.
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Old 27.08.2021, 18:09
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Re: GP refusing to do a medical referral without the specialist name on it

And I’d seriously think about changing the GP. Just ask your insurance to recommend another, and tell them why you want to change.
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Old 27.08.2021, 19:03
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Re: GP refusing to do a medical referral without the specialist name on it

How bizarre ..

My doc will recommend a specialist that she knows of but it's just that, a recommendation.. I'm still free to choose another one and if I do she'll ask me how they were so she knows for other people.


The referrals are more just for the insurance model, we are all free to book directly with whomever we want - generally speaking at least, assuming they are taking new patients etc.

I book any referals myself, it's never done by my GP.
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Old 27.08.2021, 19:50
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Re: GP refusing to do a medical referral without the specialist name on it

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I'm finding myself in a deadlock situation with regards to consultation with a medical specialist:

- My health insurance model is based upon agreement on the medical specialist (Assura Qualimed) which forces me to "discuss" with them the choice of specialist so they can propose me 2 or 3 names. For that, they need first a medical referral (Überweisung) saying that I need indeed to see a specialist (which comes to the usual GP model).

- After seeing my GP, he refuses to do any specialist referral if he's not sending it to a specific doctor with a name on it.

I know some countries where the GP usually gives you a referral document without a name on it saying "to whom it may concern" or "dear cardiologist colleague". The insurance company tells me that this is also done on CH while the Swiss GP says that in CH this is not done ("we're in ZH and here we don't do things like that!" ) and he needs someone to send it to.

I don't think I will get any good of this situation and I simply need to either change my insurance model or my GP (or, better, both of them). Out of curiosity, who's right? Is a referral document without a specialist name on it something you can get from your GP in CH?
This sounds very unusual, and makes me wonder whether you have perhaps misunderstood some part of the process.

There are two, possibly even three different aspects, to check, about the type of insurance cover you have selected.
  • Telemed: This is typically about requiring you to phone to "discuss" the need for a treatment. They are trying to cut down the costs by preventing silly patients from rushing all over from one doctor to the next, and to stop greedy specialists from taking in any old walk-in patients, and to stop lazy GPs from just referring anyone to anywhere.
  • Choice of doctors (in German this is called "freier Arztwahl"): Some models of insurance allow you to go to any doctor you choose, any time, others only after the Telemed phonecall, and others only those on their specific list.
  • All cantons: Some models of insurance restrict the patient to treatment in their canton of domicile.

You need to know which way you're insured in all of these aspects. If you've bought a "low choice" insurance, then yes, they can specify a list of specialists you may see.



Now, about a referral:
A GP typically refers the patient to a specific doctor whom he/she knows, or knows of, or to a specific institute which the GP respects, and not to an unnamed "dear colleague". I think that's the case - or at least, in Switzerland, I have never seen an un-named referral. So I think your GP is right, in this.

A referral is a specific, formal medical report kind of letter setting out your symptoms, treatment that the GP or you have already tried, remaining concerns, and asking the specialist to please check for x, y, or z, and anything else the specialist may see fit to test.

On the other hand, perhaps all your insurance needs is a letter saying that you need to be referred to a specialist.

I have a hunch that this situation could be easily solved - if your Telemed line would give you a specific address to which to write (ideally mail, but if not, postal, and include the name of the person to whom you spoke, on the phone) - with a two-line mail from your GP to the insurance saying that he is of the opinion that you must be referred. If he can't or won't write to the insurance, he could write the same to you. And then you could send that on, to the insurance company.


Besides that, it might help to know whether your GP does, in fact, have a specific specialist or institute in mind. If that case, he could add those name to the short mail. Perhaps that would suffice, for the insurance company to have a way of opening their docket, and they would probably then write back to say:
  • "Yes, it is permitted to see the specialist you recommend," or
  • "No, that specialist is not on our list, and we recommend Dr. A, Dr. B, or Institute C."
Once he has received that, the GP can address his referral to the specific doctor or institute, by name.



In any event, you have a right to copies of everything in your file.
I never leave the doctor's rooms until I have either a print-out or am certain that I will receive the document by mail.

Last edited by doropfiz; 28.08.2021 at 12:17. Reason: clarity
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Old 28.08.2021, 13:20
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Re: GP refusing to do a medical referral without the specialist name on it

Another side to this:

I wanted a second opinion prior to surgery, and preferred to go to a specialist who I had seen previously for that.

My GP could not send me to that specialist, as the Praxis had a sort of network of referral specialists, and the doctor I wanted to see was not part of that network. Again, nothing to do with my insurance type, as mine allows me to see anyone I choose. Rather, this was an internal policy of the practice.

To add to that I could not see my preferred specialist on my own, because this specialist, not my insurance, required a GP referral for every appointment.

This is fairly common in my area. Many specialists will not see a patient without a referral. As above, this has nothing to do with insurance - mine allow me to self-refer, for instance - but rather it is because these specialists are too busy to see patients who have not been 'pre-screened' by a GP.

---

So - the need for a letter specifically addressed to a certain doctor might be due to factors that have nothing to do with your insurance.

---

As always, I'll toss in the YMMV. There are plenty of posts on EF showing that others have been able to self-refer to anyone they want.

I would guess the restrictions I face are largely because I live in an area that is not well-served by medical providers. The few we have in the area seem to rely on GPs as gatekeepers to manage patient load.
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Old 28.08.2021, 14:46
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Re: GP refusing to do a medical referral without the specialist name on it

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This sounds very unusual, and makes me wonder whether you have perhaps misunderstood some part of the process.

There are two, possibly even three different aspects, to check, about the type of insurance cover you have selected.
  • Telemed: This is typically about requiring you to phone to "discuss" the need for a treatment. They are trying to cut down the costs by preventing silly patients from rushing all over from one doctor to the next, and to stop greedy specialists from taking in any old walk-in patients, and to stop lazy GPs from just referring anyone to anywhere.
  • Choice of doctors (in German this is called "freier Arztwahl"): Some models of insurance allow you to go to any doctor you choose, any time, others only after the Telemed phonecall, and others only those on their specific list.
  • All cantons: Some models of insurance restrict the patient to treatment in their canton of domicile.

You need to know which way you're insured in all of these aspects. If you've bought a "low choice" insurance, then yes, they can specify a list of specialists you may see.

You got it wrong, OP got it right. He wrote which mode he has, it's 'Qualimed':
https://www.assura.ch/de/produkte/gr...erung/qualimed


It is fairly new model where insurance company gives you 2-3 choices of specialist from which you choose - idea behind it to have more cost control.
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Old 28.08.2021, 15:16
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Re: GP refusing to do a medical referral without the specialist name on it

Oh, good, those steps in the link you posted set out exactly what OP has to do. Thank you.
  1. See his GP. Done.
  2. Phone the Qualimed. Done.
  3. Qualimed then gives him the names of 3 of their recommended specialists, and helps him to get the appointment.
  4. Then, since he knows to which specialist he'll be going, he asks his GP to write the referral to that specific doctor, with a copy to him.

OP, from the link Jaceq posted, it looks fairly straightforward. Now I'm confused: which part of this is not working, for you?
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Old 28.08.2021, 16:03
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Re: GP refusing to do a medical referral without the specialist name on it

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Oh, good, those steps in the link you posted set out exactly what OP has to do. Thank you.
  1. See his GP. Done.
  2. Phone the Qualimed. Done.
  3. Qualimed then gives him the names of 3 of their recommended specialists, and helps him to get the appointment.
  4. Then, since he knows to which specialist he'll be going, he asks his GP to write the referral to that specific doctor, with a copy to him.

OP, from the link Jaceq posted, it looks fairly straightforward. Now I'm confused: which part of this is not working, for you?
Completely agree - OP - if you don’t like the low premiums you are paying, then switch to a different model (will be more expensive), where you aren’t restricted! It won’t help in this already existing case, but you should maybe consider it in future. All of Switzerland has the obligation to pay for health insurance - it’s up to each individual to decide on the constraints vs. costs to take into account. Once decided, then you can’t suddenly switch from a ‘basic’ to a ‘premium’ choice of treatment.

I don’t care which country you are from, when taking out insurance, you need to inform yourself.

Last edited by ZuriRollt; 28.08.2021 at 16:15.
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Old 28.08.2021, 16:30
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Re: GP refusing to do a medical referral without the specialist name on it

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I'm finding myself in a deadlock situation with regards to consultation with a medical specialist:

- My health insurance model is based upon agreement on the medical specialist (Assura Qualimed) which forces me to "discuss" with them the choice of specialist so they can propose me 2 or 3 names. For that, they need first a medical referral (Überweisung) saying that I need indeed to see a specialist (which comes to the usual GP model).

- After seeing my GP, he refuses to do any specialist referral if he's not sending it to a specific doctor with a name on it.

I know some countries where the GP usually gives you a referral document without a name on it saying "to whom it may concern" or "dear cardiologist colleague". The insurance company tells me that this is also done on CH while the Swiss GP says that in CH this is not done ("we're in ZH and here we don't do things like that!" ) and he needs someone to send it to.

I don't think I will get any good of this situation and I simply need to either change my insurance model or my GP (or, better, both of them). Out of curiosity, who's right? Is a referral document without a specialist name on it something you can get from your GP in CH?
Are you saying that Qualimed is refusing to give you the list of specialists until after you've provided a letter from your GP stating that you need to see a specialist? And he won't write the letter until he has the list?
That's rather a catch-22 situation..... and would mean that no-one using that particular healthcare system would ever get to see a specialist.

Speak to your insurance again, asking for a copy of their referral system in writing, or ask the GP to ring them and check exactly what they want him to do.
It seems likely there's a simple misunderstanding somewhere.
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Old 28.08.2021, 19:58
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Re: GP refusing to do a medical referral without the specialist name on it

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You have a right to all documents in your file. Just say you want a copy. End of story.
Only if you paid for it, directly or indirectly. For instance, the results of a consultation, a diagnosis (if there is one), or a lab report.

The doc's personal notes, for instance as the result of research, are probably a different matter.
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Old 28.08.2021, 20:20
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Re: GP refusing to do a medical referral without the specialist name on it

OP, I was curious, as I’ve never heard of your heath insurer. And even the homepage describes exactly what you’ve described.

https://www.assura.ch/de/produkte/gr...erung/qualimed

You agreed to this form of coverage when you took out the contract. And you hopefully profited from the savings on your insurance premium.
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Old 28.08.2021, 20:46
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Re: GP refusing to do a medical referral without the specialist name on it

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- After seeing my GP, he refuses to do any specialist referral if he's not sending it to a specific doctor with a name on it.
Have him refer you. Then request the original of the referral letter, I would think that he has to hand it out as it's part of your patient file. Alternatively request it from the specialist.
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Old 29.08.2021, 11:56
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Re: GP refusing to do a medical referral without the specialist name on it

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Only if you paid for it, directly or indirectly. For instance, the results of a consultation, a diagnosis (if there is one), or a lab report.

The doc's personal notes, for instance as the result of research, are probably a different matter.
Yes, but in this case we are talking about a referral letter, which would not be considered personal notes.
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Old 29.08.2021, 21:30
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Re: GP refusing to do a medical referral without the specialist name on it

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Yes, but in this case we are talking about a referral letter, which would not be considered personal notes.
Except you aren't. You made a sweeping claim that's false.
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