Annual referral for specialist appointments with a LIFE LONG disease..

[sleepallday]

So today I got told next time I need to see my specialist, I'll need a new referral from my GP. I have Crohns Disease, a life long incurable illness? Why do I need to go a GP, tell THEM what I have and that I need them to print me a referral for $80 and a waste of both of our time. Plus it also means for each new referral each year, I will have to pay a first time visit fee (which is a lot higher), even though I've been at their clinic what feels like a million times.

I am a regular patient, literally my specialist is pleading my case to other medical professionals at a conference to get their opinions on whether to proceed with surgery or not.

What the hell Australia?

Has anyone experienced this before?

I just found information online about indefinite referrals. Do they work?

This is all so frustrating! I have to work extra shifts to be able to afford going to medical appointments/ medications etc, now another hoop to jump through.
It feels like one big conspiracy theory- make the crohns patients stress more over stupid referrals = more symptoms = more appointments = more money for them.

Sorry for the rant but I am so put off right now..

 

[Catherine]

Lara

Paging DustyKat as each state is slightly different.

Ring GP's office see whether an appointment is necessary for the referral.

If you need an appointment ask for the appointment to be bulk billed.

You could wait see whether need to appointment for something else and get written during that appointment. Also the 12 months starts from the date the referral written.

The GI should not charge you a new patient fee just because you have a new referral. My understanding is the GI can see without an in date referral but you would not be able to claim the Medicare rebate.

The longest referral I managed to get is two years.

 

[alex_chris]

Am not in Australia, just wanted to say this GP referral system to specialists exists in many countries. It's considered a cost cutting measure, but essentially isn't in many cases. I don't even have a GP here as the last time I needed a GP was 15 years ago. Since then every single thing medically happening to me was Crohn's related... Or required a specialist (regular checks for skin cancer, dentist etc.). Not sure how a GP referral would help here.

I have lived in the UK for a while and have seen how utterly useless the GP referral system for Crohn's patient is there. Sorry it is an extra burden on you.

 

[afidz]

DustyKat, any suggestions?

 

[DustyKat]

Referrals fall under the realm of Medicare so the rules relating to them are the same nationwide.

Referrals from a general practitioner (GP) are valid for 12 months, unless stated differently on the referral letter/note. For example, a referral could be valid for three, six or 18 months, or be indefinite.

The validity period of a referral is from the date of the first specialist appointment. For example, your GP refers you to a specialist in June. You ring the specialist’s rooms and they tell you the first available appointment is September 9th. You accept that date and attend on that day. That is when the validity period starts.

A GP may write an indefinite referral for a chronically ill patient who is in the continuing care and management of a specialist or consultant physician for a specific condition (e.g. glaucoma).

Crohn’s would fall under this category and it is actually a requirement of Medicare that these sort of referrals are accepted by specialists. This is supposed to be the stock standard procedure. Because this does not happen as it should there is much angst from many in the medical profession, namely GP’s, about specialists rorting the system.
That said, should there be a change in your condition that leads to a consultation outside of what would be expected then it is reasonable that a new referral is written. For example, you see a GI for a period of time whilst you are flaring and you then attain a state of remission. The GI then sets your appointments at say 6 monthly intervals. Some time down the track you go to the GP with all the symptoms of a flare. Under these circumstances it would be expected that the GP would write a new referral stating the change in your condition…but it should then be another indefinite referral.

Referrals from specialists and consultant physicians are valid for three months unless the referred patient is an admitted patient. The referral for admitted patients is valid for three months, or the duration of the admission, whichever is the longer.

As stated here, specialist to specialist referrals are for 3 months only. We fell into this trap when my daughter was referred from a paediatrician to the GI. As soon as I realised I then had the GP do the referrals.

………..

So long story short…yes, indefinite referrals do work and under the rules of Medicare they must be accepted by a specialist unless there has been a change in your condition. My son has an indefinite referral.

I hope that helps Lara and makes sense!

Dusty. xxx

 

[UnXmas]

Am not in Australia, just wanted to say this GP referral system to specialists exists in many countries. It's considered a cost cutting measure, but essentially isn't in many cases. I don't even have a GP here as the last time I needed a GP was 15 years ago. Since then every single thing medically happening to me was Crohn's related... Or required a specialist (regular checks for skin cancer, dentist etc.). Not sure how a GP referral would help here.

I have lived in the UK for a while and have seen how utterly useless the GP referral system for Crohn's patient is there. Sorry it is an extra burden on you.

I'm in the UK and rely so much on my GP. I have multiple permanent illnesses, two surgeons, more consultants than I can count, locally and in London, and my GP still sees me once a fortnight. She coordinates things, oversees my repeat prescriptions, prescribes me new things if they're not too specialised, monitors my weight, and refers me to a new consultant if I need one. If I want to be referred back to a consultant I've seen in the past, her referral letter updates them on everything that's occurred since I last saw them. My GP is vital (though maybe I'd think her not quite so vital if I had to pay...).

Lara, I'm sorry my answer is no help to you, but I definitely feel the GP referral system has benefits.

 

[M West]

Haven't seen a GP for 40+ years.

It's personal for me as my GP of 40 years ago misdiagnosed my Crohn's for 3 years and would not refer me to a GI until he was threatened with a law suit.

I am not familiar with your Country's medical system and practices. I hope you get answers and relief soon.

Miles

 

[alex_chris]

I'm in the UK and rely so much on my GP. I have multiple permanent illnesses, two surgeons, more consultants than I can count, locally and in London, and my GP still sees me once a fortnight. She coordinates things, oversees my repeat prescriptions, prescribes me new things if they're not too specialised, monitors my weight, and refers me to a new consultant if I need one. If I want to be referred back to a consultant I've seen in the past, her referral letter updates them on everything that's occurred since I last saw them. My GP is vital (though maybe I'd think her not quite so vital if I had to pay...).

At the end it certaintly very much depends on every single case. GP referrals are still another complication on top of a burdensome system. For instance, I have yet to see the reason why drugs such as azathioprine require prescription. It's not like people go to a pharmacy to purchase aza and use it for any purpose other than treating an illness like Crohn's. For over 10 years I have been required to get monthly prescriptions. I would be perfectly happy to pay the full price myself and get a year's worth of aza, but nope... the system doesn't allow it.

 

[DustyKat]

In Australia the GP is the cornerstone of our care. This does have its advantages as the GP is the co-ordinator of all your care and as a result your healthcare is less fragmented. All correspondence is directed back to the GP either as the primary recipient or as a secondary recipient via cc between specialists, hospitals, etc. Like the UK they also manage your ongoing care between specialist visits. Also in Australia there are no boundaries between Medicare controlled health services as it is federally managed. This allows for a seamless sharing of health records between health professionals, by that I mean you don’t run into issues of…we own that therefore we won’t share it with you. There are failures in every system but on the whole it does work well.

All that said perhaps we best get back to what the op was asking and not derail the thread any further.

Dusty.

 

[UnXmas]

At the end it certaintly very much depends on every single case. GP referrals are still another complication on top of a burdensome system. For instance, I have yet to see the reason why drugs such as azathioprine require prescription. It's not like people go to a pharmacy to purchase aza and use it for any purpose other than treating an illness like Crohn's. For over 10 years I have been required to get monthly prescriptions. I would be perfectly happy to pay the full price myself and get a year's worth of aza, but nope... the system doesn't allow it.

I get free prescriptions due to having a stoma, but did you know you can get a three-monthly or yearly prescription pre-payment certificate?

 

[Samboi]

You can go to a bulk billing clinic to get your referral - then there is no direct out of pocket expense.
You can request an ongoing referral - but not all specialists will accept them.
If you know your GP well - save yourself the trip and request your referral over the phone. They can fax it through to the specialist and might not pcharge you or charge you a nominal fee.
There are good reasons for having your GP in the loop and co-ordinating your health care.
Although I always feel sorry for mine as she always mentions how many letters she receives from the specialists about my care etc. She does a great job managing my referrals.