Learn what a health care specialist does, when you may need one, and how referrals and insurance coverage work.
Your primary care doctor helps with everyday health needs, like treating colds and doing annual checkups. But if you need more specialized care, a specialist can help.
A health care specialist is a doctor with advanced training in one area of the body, a specific disease, or an age group. They're experts in their field and can diagnose and treat more complex issues than a primary care doctor can. If you need targeted care, a specialist is probably the right person to visit.
A specialist might be right for you if you have a symptom that won't go away. If you have a strange rash that doesn’t clear up or a stomachache that lasts for months, you need an expert to figure out what is wrong.
You might also need a specific treatment or surgery. Your primary care doctor can't perform a knee replacement or remove a tumor. They will refer you to a surgical specialist who regularly does those procedures.
Chronic conditions like diabetes, heart disease, or cancer may need ongoing care from a specialist who knows the newest medicines and treatments for that exact disease. Going to an expert helps you get the best possible care for long-term health issues.
There are dozens of different kinds of specialists. Here are some of the most common ones you might visit and how they can help you with a health issue.
A cardiologist is a heart doctor. You might go to one if you have high blood pressure, chest pain, or a family history of heart issues.
This specialist focuses on your skin, hair, and nails. They treat things like severe acne, look at unusual moles, and help with uncomfortable skin rashes.
Orthopedists take care of bones, joints, and muscles. You might go to one if you break a bone, get hurt playing sports, or have painful arthritis.
A gastroenterologist is a doctor for your stomach, intestines, and liver. They help with problems like heartburn, ulcers, or ongoing belly pain.
This is a doctor who cares for your eyes. You might visit an ophthalmologist for vision problems, eye injuries, or to get tested for diseases like glaucoma.
An endocrinologist specializes in glands and hormones that control things like growth, energy, and blood sugar. They can help with conditions such as diabetes, thyroid problems, or other hormone-related issues.
If you feel your health needs extra attention, talking to your doctor about a specialist is a good first step.
Start by sharing your symptoms and concerns openly. Let your primary care doctor know if your health issue isn’t getting better or if you think another doctor’s expertise could help. Your doctor knows your health and can advise whether visiting a specialist makes sense.
Don’t hesitate to ask direct questions like, “Should I go to a specialist for this?” or “Would another doctor have more answers?” This helps you work together to find the right care for you.
Not following your health insurance plan’s rules can lead to higher out-of-pocket costs. Before scheduling a specialist appointment, know how your benefits work. You should:
- Check if you need a referral. For many Health Maintenance Organization (HMO) plans, you’ll need a referral from your primary care doctor first. Without it, your insurance might not cover the specialist visit. With a Preferred Provider Organization (PPO) plan, you usually don’t need a referral and can schedule your appointment directly.
- Make sure the specialist is in your plan’s network. If they’re in-network, the specialist accepts your insurance and offers lower rates. If they’re not, your costs will likely be higher.
Specialist visits usually cost more than primary care doctor visits and may have higher copays. Some tests or procedures might need prior authorization, which means your insurance company must approve them first.
Talking with your doctor and insurance company can help you through the process.
Get reliable answers to your insurance questions, such as how to get prior authorization and submitting a claim.
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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