Is a Specialist Needed?

If your loved one has a skin problem, you might suggest they call a dermatologist. For their hurt ankle, you might look for an orthopedist. However, their primary care provider (PCP) should be your go-to resource. The PCP can guide you to any other needed healthcare, including a specialist who treats specific illnesses or parts of the body. This helps make sure that doctors are working together to give your loved one high-quality care that’s right for their medical history.

Start with the PCP 

For medical care that isn’t an emergency, start with your loved one’s PCP.

“Primary care providers are trained to take care of common things uncommonly well,” explains Matthew Collins, M.D., M.B.A., vice president of clinical integration at BCBSRI. “They know the patient, their history, and their wishes for your health. Patients should always seek their advice about care and keep them informed about medical needs.”

PCPs may be able to treat problems themselves rather than sending your loved one to a specialist. That can save time and money. This is especially true if your loved one has a chronic but manageable condition such as diabetes or asthma. “Patients should reasonably expect to be able to get regular care for these types of conditions from their PCP,” Dr. Collins says.

If the PCP recommends seeing a specialist, ask for one in the network of your loved one’s health plan. (Some plans require a referral from a PCP, so be sure to check first.) If your loved one belongs to an Advance Primary CareSM practice, you know they’ll be referred to a specialist that offers high-quality, cost-effective care. For more information on Advance Primary Care, please see the information later in this article.

Preparing for your specialist appointment 

While your loved one is seeing a specialist (and even before), the PCP and specialist should be communicating and sharing information, including medical records, test results, and appointment notes. This helps the doctors coordinate their efforts to ensure your loved one gets the best care and experience.

While not a replacement for human communication, technology also plays a part. Electronic health record (EHR) systems are now widely used throughout the healthcare system to share information. Joseph Mazza, M.D., a cardiologist with the Cardiovascular Institute of New England in Woonsocket, says, “EHRs have become a much needed central repository for efficiently sharing critical information among all providers involved in a patient’s care.”

What to ask 

When seeing a specialist, your loved one should ask all of the questions listed below.

  • Do you have a lot of experience treating patients with conditions like mine?
  • Which hospitals can you admit to? If surgery is involved, ask about the hospital where the specialist wants to perform the operation.
  • Do I really need surgery/tests or is there something else I can do to help the problem (for example, exercises at home)?

“I encourage patients to bring written questions to their appointment. I set aside time for them to ask their questions during a visit,” says Dr. Mazza. “Communication is a two-way street and one of the most important parts of the patient-doctor relationship.”

Common specialists used by BCBSRI members


  • Cardiologist: Heart disease
  • Dermatologist: Skin problems
  • Gastroenterologist: Stomach problems
  • Oncologist: Cancer
  • Orthopedist: Bone and joint conditions
  • Otolaryngologist: Ear, nose, and throat (ENT)
  • Psychiatrist: Mental/emotional illnesses
  • Pulmonologist: Lung issues

Last updated: 01/01/2018

H4152_2018web5 Approved

Blue Cross & Blue Shield of Rhode Island is an HMO plan with a Medicare contract. Enrollment in Blue Cross & Blue Shield of Rhode Island depends on contract renewal.

* Blue MedicareRx (PDP) is a Prescription Drug Plan with a Medicare Contract.

Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont are the legal entities which have contracted as a joint enterprise with the Centers for Medicare & Medicaid Services (CMS) and are the risk-bearing entities for Blue MedicareRx (PDP) plans. The joint enterprise is a Medicare-approved Part D Sponsor. Enrollment in Blue MedicareRx (PDP) depends on contract renewal.