To ensure co-ordinated care, and to minimise unnecessary costs, members should be referred to any specialists by their GP. To create a specialist referral, the GP needs to access the Medscheme interactive voice system to obtain a specialist referral number.
The referral number will apply to either a type of specialist (for example, a dermatologist) or a specific specialist for a period of time that the GP decides on, which can be up to 6 months. The patient still has the choice of which specialist to visit.
There are some exceptions to this rule and members will not need a specialist referral number in the following instances:
- 1 visit per year to a gynaecologist for a gynaecological check-up and pap smear for female patients
- 1 visit per year to a urologist for a check-up for male patients
- Visits to a paediatrician for children under 1 year of age
- Visits to optical and dental specialists
- Maternity consultations by a gynaecologist
- Medical management under the Prescribed Minimum Benefit treatment plan
In case of an emergency, where a patient had to consult a specialist without prior authorisation, a referral number can be obtained after the visit. The patient would need to contact his/her GP to obtain the referral number within 72 hours of the emergency.
Members should remember that obtaining a referral number from a GP is not a guarantee of full payment – specialist consultations will be paid up to the Medical Scheme Rate, or such rate as agreed with the specialist, and subject to available benefits.