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Different interpretations

September 24, 2019

I’ve lived all my life in Australia (barring one year when I lived in Canada), and thus have been covered by Medicare, Australia’s health system. One of things that’s always been a feature of Medicare is the need to get a referral from a GP to see a specialist (I can’t remember if this was ever not the case, as it’s been so entrenched for much of my working life [Medicare officially started in 1984]). I say it’s a ‘feature’ though it’s often seen as a bug by the public, especially those with long-term conditions that need specialist treatment.

What the referral system does is stop Jo Public from calling a specialist for an appointment for every tiny little thing — it acts as a filter to stop overloading specialists with matters that can be dealt with by a GP. However, it does require a visit to the GP (at normal consultation rates) to get the referral, as well as the cost of the specialist if you are referred. So some people rightly feel like they’re paying twice.

And so to interpretation… In all the time Medicare has been in existence (45 years), I’ve always assumed that the date on the referral letter from the GP was the date the referral (typically 12 months) started from.

But not so, as my GP informed me yesterday when I asked him to post-date a referral closer to the time of the specialist’s appointment. It seems that post-dating a referral like this is deemed fraud in Medicare’s eyes, and then my GP explained that the date of referral starts from the date you see the specialist after being referred, NOT the date on the referral letter!

Well, call me surprised! He told me that many medical receptionists get this wrong too, which may have contributed to my belief that the date of the referral letter was the date the 12 months starts from.

I checked the Medicare website and it clearly states ‘date you see the specialist’ under the ‘Referral periods from a GP to a specialist’ subsection on this page: https://www.humanservices.gov.au/organisations/health-professionals/subjects/referring-and-requesting-medicare-services

[Link last checked September 2019]

2 comments

  1. Rhonda

    Did you now you can get an ongoing referral for a long term chronic complaint which saves you having to go back to the GP on an annual basis. I have forgotten what they are called but I have one which enables me to get an annual appraisal from the specialist to ensure my condition is still in remission.

    Bill


  2. Hi Bill

    Yes, I knew that and my husband has one for an ongoing skin condition. However, some GPs are reluctant to write an indefinite referral, and some specialists won’t accept them and want a new referral every year. In my case, I don’t have a chronic condition, but the specialist has recommended I see him every two years or so for a monitoring check. My previous referral expires in late Oct, but the earliest appointment I could get with the specialist was mid-Dec, so that’s why I needed a new referral and asked for it to be dated in early December. Which is when I found out about the date a referral kicks in.

    –Rhonda



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