Earlier this week, we covered sourcing referrals from healthcare providers and how the referral process works. Today we want to distinguish between referrals and recommendations. Let’s dive in!
Referrals pertain to a written order from one’s primary care provider for a client to see a specialist or receive specific medical services. In many HMOs, one needs this type of formal referral before getting medical care outside of their physician’s office. Think, for example, of when you needed a referral to a GI specialist. This came from your primary care provider (or perhaps your physician assistant or nurse practitioner), allowing you to see this particular specialist and potentially have the visit covered by your insurance.
PCPs (and sometimes PAs and NPs) can provide referrals to dietitians if an insurance company deems that a referral is required for a member to see an RDN; Healthy Bytes validates such referrals during an eligibility estimate on behalf of you and your client to help with the reimbursement process.
Recommendations, on the other hand, involve you actively networking with other healthcare professionals in your community who can then suggest that their client visits you for your nutrition expertise. This is ideal if you are actively trying to grow your client base. In this scenario, no formal referral paperwork is exchanged between provider and payer. More on ideas for who to reach out to proactively next week!
What questions do you have about referrals versus recommendations?