Everything you need to know about medical specialists

Man talking to a medical specialist


Published August 2026
Words by Angela Tufvesson

Appointments with medical specialists can feel daunting – but once you know what to expect, it’s much easier to navigate.

A trip to the GP that ends with a specialist referral can catch you off guard. Maybe it's a skin irritation that needs a closer look or a backache your doctor wants to get to the bottom of. Either way, seeing a medical specialist can be daunting, especially if you aren’t feeling your best.

Research shows one in five Aussies who need specialist care delay or skip it, often because of wait times or cost. This can mean missed diagnoses, conditions that get worse and more medical expenses down the track.

If you’ve received a referral or aren’t sure if you need one, here’s what to know about medical specialists.

First, what are medical specialists?

A medical specialist is a doctor who’s an expert in a particular field of medicine. Specialists are found in all areas of medicine, with some of the most common including:

  • cardiologists
  • dermatologists
  • gynaecologists
  • obstetricians
  • oncologists
  • paediatricians
  • urologists.

Other health professionals like psychologists also offer specialised care and may require a referral.

Do you need a referral to see a specialist?

Generally, you will need a referral to see a specialist. Some specialists won't see you without one. A referral also lets you claim a higher Medicare rebate, which means lower out-of-pocket costs.

How do you get a specialist referral?

Your GP is the best place to start. They can assess your situation, recommend a specialist and write you a referral.

GP referrals to specialists can be ‘open’, which lets you choose your own specialist. You can also change specialists and keep your referral, as long as they’re within the same medical field.

Most referrals last for 12 months from your first appointment (not from the date it was written). For ongoing or chronic conditions, your GP may give you a longer-term or ‘indefinite’ referral so you're not constantly renewing it.

What about medical fees?

If your specialist charges more than the scheduled fee set by the government (which is common), normally Medicare covers part of the cost and you pay difference, or the "gap".

Your first appointment usually costs more, but it also comes with a higher rebate. Follow-up visits usually have lower fees and a lower rebate to match.

If your out-of-pocket costs reach a certain threshold in a calendar year, Medicare will give you higher rebates for the rest of the year – handy if you're seeing doctors regularly.

The quickest way to claim Medicare rebates is at your specialist’s office – when you pay, just ask the receptionist if they can make an electronic claim for you on the spot. You can also submit an online claim (usually reimbursed within seven days), send a claim form via mail, or visit a service centre to claim in person.

Choosing the right specialist

One of the benefits of private health cover is you can choose which specialist you see. RT Health members can use the Find a Doctor tool to search specialists by specialty, suburb, postcode or hospital. Your GP can also help point you in the right direction.

When weighing up your options, consider:

  • their qualifications and experience
  • availability and wait times
  • location
  • cost.

The Medical Costs Finder is a free Australian Government website where you can look up specialist fees, see what Medicare usually covers and get an idea of what you may need to pay.

Questions to ask your specialist

If you're treated by a specialist as a patient in a public or private hospital, your health cover may cover some of the costs. Asking these questions can help you understand your care and any out-of-pocket costs.

  • Do you participate in RT Health’s Medicover program?

Choosing a doctor who participates in our Medicover program can reduce what you’ll pay out of pocket. If your specialist participates in Medicover, you'll either have no out-of-pocket costs or you'll know exactly what you'll need to pay before your appointment, so there are no surprises.

  • Do you work from a Medicover-participating private hospital?

RT Health members can reduce or avoid out-of-pocket costs by choosing a Medicover-participating private hospital. Your specialist might work across several hospitals and it’s worthwhile checking if any of them participate in Medicover.

  • Will there be any other doctors involved in the treatment?

Other doctors involved in your care (like anaesthetists or surgical assistants) may bill separately. Ask who else is involved and what their fees are.

  • Are there any extra costs involved and what are they?

Some procedures involve surgical implants or devices, like a stent or an artificial hip, or single-use parts used during robotic surgery. These aren't always fully covered, so it's worth checking with your specialist beforehand so you know what to expect.

  • What are the total fees of the procedure or treatment?

Before you go to hospital, ask for a confirmed total (not just an estimate) from each specialist involved. It’s the best way to avoid unexpected medical expenses after your procedure.

Not sure if your hospital treatment is covered?

We get it. Private health insurance can be complicated, but we’re here with you every step of the way. If you have any questions about your cover, our Member Care team can help you find the answers. Call us on 1300 886 123 or email help@rthealth.com.au


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