A referring physician is a term that describes the physician who has sent a patient to another facility in order to conduct further examination or surgery on a particular medical condition.
This referral is usually necessary simply because the general practitioner in a clinic for example, does not have the specialist knowledge to diagnose or don’t have the required equipment to run certain procedures.
One common example is a referral request to send a patient to a radiologist center so that x-rays can be done. Having radioactive equipment in the heartlands can be a hazard to residents as there might not be the necessary setup to keep such machines safe.
That’s without mentioning that for a general practitioner to invest such a huge amount of money on these machines might not be economically practical at all.
From the economics side of things, it’s not uncommon for a clinic to only refer to a particular service provider as they have prior tied-up arrangements with each other.
This helps a clinic earn referral fees from the third party service provider as the terms of profit-sharing has already been laid out by the partners.
Should a clinic doctor refer a patient to a service provider that it has no prior relationship with, then the referring clinic might not earn a referral fee as there has been no referral agreement at all.
There is also a more logical reason for referrals in this industry.
In Singapore, referral letters written by referring physicians are usually required for citizens to enjoy subsidies on medical costs.
This is because while the government is more than willing to subsidize the the medical costs of specialist care, consultation and treatments to citizens, a lack of a proper qualified referral source can lead to abuse and put strain on the healthcare system.
If walk-in patients at specialist centers are offered subsidies without credible referral sources, then such establishments might be flooded with patients who don’t necessarily need specialist attention but think they do.
Referring physician and insurance policies
In some types of medical insurance, exclusions can sometimes be expressly stated concerning the continued role of referring physicians after the referral has taken place.
What and how continuity fees are charged can determine whether certain medical expenses can be reimbursed by the insurer.
When making claims from insurance policies, claimants are required to fill up a claim for to document the claim.
This is so that there is proper recording of the relationship between the insurer and the insured.
These forms often contain a section where the claimant has to disclose the name, address and other contact details of the referring physician.
These information might play a crucial role should investigations be conducted by the insurer to assess the legitimacy of claims so that they can ensure that no fraud has taken place and that they have not been taken advantage of by an opportunistic policy holder.
Insurance companies are well-known to be very active in fighting against false claims so as to deter people from attempting them.
