How to find a specialist: Understand referrals, rebates and more

Updated May 2026 | 5 min read
Words by Angela Tufvesson

Key takeaways

• A specialist is a doctor who is an expert in a specific area of medicine. 
• Your GP can give you a referral and help you find a specialist.
• A referral allows you to claim a higher Medicare benefit and lower your out-of-pocket medical expenses.
• If your specialist charges more than the scheduled fee set by the government, you may have to pay the difference.

Need to see a psychologist, paediatrician or cardiologist? Here’s how to get a referral, find a specialist and manage out-of-pocket costs.  

Choosing a specialist can feel overwhelming – especially when you’re already dealing with a health concern. From figuring out whether you need a referral to understanding Medicare rebates and potential out-of-pocket medical expenses, the process can quickly become confusing.

Australians are increasingly worried about healthcare expenses. A report commissioned by Private Healthcare Australia found that in 2024, almost one in three Australians has delayed or cancelled specialist care due to cost in the past three years.

If you’re trying to find a specialist who’s right for you, a little know-how can make a big difference.

Do you need a referral to see a psychologist, surgeon and other specialists?

A specialist is a doctor with expertise in a specific area of medicine. Specialists are found in all fields of medicine, with some common examples including:

• anaesthetists
• cardiologists
• dermatologists
• gynaecologists
• obstetricians
• oncologists
• paediatricians
• radiologists
• surgeons
• urologists.

It’s generally best to see a specialist with a referral from your GP. This is because a referral allows you to claim a higher Medicare benefit, which reduces your out-of-pocket costs. Other health professionals like psychologists also provide specialised care, and you may still need a referral to claim Medicare benefits.

Some specialists ask for a referral from all patients before you can book an appointment. While you can see certain specialists without a referral, you’ll need one to claim a Medicare rebate.

How long does a specialist referral last?

A referral from your GP to a specialist lasts for 12 months from your first appointment with the specialist – not from the date the referral was issued. It's important to remember referrals can't be backdated so you'll need to get a new one from your GP if it expires. Your GP may also choose to give you a referral for a longer period of time, or an ‘indefinite referral’ if you need ongoing care – for example, if you have a chronic condition. But you’ll need a new referral if you develop an unrelated health issue.

A referral can be transferred to any specialist you choose, as long as they’re in the same medical field. The only exception is if accessing private services at a public hospital outpatient clinic. You also don't need to choose a specialist to get a referral. You can ask your GP for an open referral. This means you don't need to make a decision on the spot or go with the specialist your GP may recommend.

How do Medicare rebates work with specialists?

When you have a consultation with a specialist in their rooms, private health insurance doesn’t cover the cost because Medicare pays for all or part of these services. If you’re treated by a specialist in a public or private hospital, your private health insurance may cover some of the costs.

Your first consultation with a specialist is typically more expensive and attracts a higher Medicare rebate. Any follow-up appointments usually have a lower fee and a lower Medicare rebate.

If your specialist charges more than the scheduled fee set by the government – which is common, as specialists can choose how much they charge – you may have to pay the difference. If your out-of-pocket costs reach a certain threshold in a calendar year, Medicare gives you a higher rebate for the rest of the year.

How long do Medicare rebates take?

When paying for your consultation in full at the end of your appointment, ask if the specialist can make an electronic claim. If they can, they’ll submit it on the spot and Medicare will pay your benefit into your nominated bank account.

If an on-the-spot claim isn’t possible, you can then submit a claim through your Medicare online account, in person at a service centre or by mail.

When you submit your claim online, you’ll usually get your benefit within seven days. When you submit your claim by mail or in person, you’ll usually get your benefit within 21 days from when Medicare receives it.

How to find a specialist who’s right for you

When you have private health cover, you can choose which specialist you see. You can use our Find a Provider tool to find an extras provider, doctor or surgeon who participates in HCF's provider networks depending on your condition.

You can also ask your GP to recommend a specialist or help you find a suitable specialist for your health condition. Our partnership with GP2U, an online video GP service, makes it easier for eligible members^* to access telehealth services, including a standard GP consultation (up to 10 minutes) for a fee of $50. Eligible rural and remote members^{^} can access an annual 15-minute online GP consult with GP2U, at no cost.

To give you an idea of the cost, Medical Costs Finder is a free Australian Government website that shows typical doctor fees, what Medicare usually covers and what you may need to pay, so you can feel more informed and confident when planning your care.

To decide which specialist to choose, you also might consider factors like their:

• qualifications
• experience
• availability
• location
• cost.

If you need treatment from a specialist in a public or private hospital as an in-patient, it’s important to ask the following questions so you’re fully informed about your care and any out-of-pocket expenses.

Do you participate in HCF’s gap scheme for hospital treatment?

Our handy Find a Provider tool can help you find a specialist who charges no-gap or a known-gap (capped at $500 per specialist) between their fees and what’s covered by Medicare.

Do you provide your services from an HCF-participating private hospital?

HCF members can avoid or minimise out-of-pocket costs by going to an HCF-participating hospital. Your specialist might carry out their services at a few hospitals. Ask whether any of these are an HCF-participating hospital or check for yourself with our Find a Participating Hospital tool.

Will there be any other doctors involved in the treatment?

There are times when other doctors will be involved in your care, like anaesthetists or surgical assistants, who may bill separately. Ask your specialist who will be involved in your procedure and whether their charges are included in the fees they’ve given you.

Are there any extra costs involved and what are they?

Your procedure might involve surgically implanting items (devices like stents or prostheses like an artificial hip) or using robotic consumables (parts used during robotic surgery that are discarded afterwards). These may be fully covered, but not always, so it’s best to check with your specialist.

What are the total fees of the procedure or treatment?

Informed financial consent means being given clear, upfront information about the likely cost of treatment before you go ahead. This includes what your doctor may charge, what Medicare and your health fund will typically cover, and whether you’re likely to have any out‑of‑pocket costs. Having this information helps you ask questions, avoid bill shock and make confident decisions about your care.

Before you go into hospital, ask each specialist (for example, you might have a surgeon and an anaesthetist) to give you their full fees so you know what you can expect to pay. Double-check you’ve been given a total fee rather than just an estimate.

A final figure is the best way to avoid unexpected medical costs after surgery. Total approximate costs for common procedures and the impact on your out-of-pocket medical expenses can be found on our Preparing for Hospital page.

Get in touch

Got questions about your health cover? Don’t hesitate to get in touch – either chat with us online or call 13 13 34 and speak to our team.