Doctor's referral: when do I need it and when don't I?
A referral to a specialist is an important and, it seems, obvious thing for most people. However, specialists from health insurance funds note that people are often unaware that in some cases a referral is not needed to receive specialist services paid for by the Compulsory Health Insurance Fund (CHIF).
Referrals for services covered by compulsory health insurance are made by family doctors or specialist doctors. Referrals are issued if a doctor needs to consult another doctor, carry out tests, adjust treatment, or provide hospital treatment because of the patient's health condition.
A referral is valid for 60 days, and even if people know this, they often think that they need to use the referral to see the doctor in the specialty it describes or to have tests done within this time. But there is no such urgency - within two months, a patient with a referral must register for the tests or specialist referred to in the referral, rather than visit. With a referral, you can register once.
It is important to know that you do not have to go to the same health facility as the referral for specialist services or tests. The referring doctor must specify at least three facilities where the required reimbursable service can be provided. However, it is up to the patient to choose - he or she can receive the service not only in his or her own clinic, in the facilities suggested by the doctor, or in the city where he or she lives, but also in any medical facility in Lithuania that has a contract with a territorial health insurance fund (THIF) for the provision of the required service. A list of all medical institutions in the country that have a contract with the National Health Insurance Fund can be found here.
This choice of treatment facility is useful when the aim is to get the service faster, i.e. to choose the facility with the shortest waiting time for the service specified in the referral. It also gives the patient a wider choice of doctors with the right qualifications if they do not wish to go to one particular doctor.
In a few cases, a referral is not needed at all to receive reimbursed medical services. Direct registration with primary dental and primary mental health specialists is possible at the health centre where the insured person is registered. Insured people can also receive dermatovenerologist (skin and venereal diseases) services, paid for by the CHIF, without a referral, at any medical institution that has concluded a contract with the THIF for these services.
In the case of a chronic disease that requires a specialist to monitor a person's health for a longer period of time, it is sufficient for the family doctor to issue a referral to the required specialist once a year. For example, a referral to an eye doctor for type 1 or type 2 diabetes with progressive eye disease.
Both insured and uninsured people should receive free and immediate emergency medical care without a referral for acute illnesses, injuries, etc. This includes first aid and emergency medical care provided in clinics or hospitals when there is a real risk to life or health or serious complications.
Only in cases of emergency, such as severe trauma, severe burns or life-threatening illness, can you go to a hospital emergency room without a referral. In other cases, you should go to your family doctor, or, during your clinic's out-of-hours hours, to the doctors on duty at the same health facility or at another one with which the patient's clinic has a contract to provide family doctor services during its out-of-hours.
Information on where medical care is available outside the opening hours of health facilities, at weekends and on public holidays is available from receptionists, on the websites of health facilities and on notice boards. This information is also conveniently available on the website of the Health Insurance Funds here.
Information from Vilnius Territorial Health Insurance Fund
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Last updated: 25-08-2022
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