>Insurance gates these but could do so with their own tech rather than relying on the third party. Could help with keeping loss ratios at the minimum.

I work in insurance. In my experience, the fact that you have to go to the doctor for a referral discourages people from getting said referral.

So the tradeoff is that you would get fewer referral-specific visits (i.e. person going to their GP to get a specialist referral) at the likely expense of more specialist visits.

Strange, I have conditions that require specialists, including a very rare type of specialty.

Never had a problem just calling them up and making an appointment. Insurance never cared either.

Different insurance plans have different restrictions. A PPO typically requires a referral while an HDHP does not.

I always use PPOs. Never had a problem.

In all fairness, I’ve been seen similar specialists for a while. That might make the situation different. “Continuing care.”

Specialists differ from GPs in that if you ask them the time, they will have their eyes open when they read the broken clock on the wall.

I have no idea what good GPs serve besides flu testing. Sounds unfair but they generally seem uninformed about pretty common medical conditions.

In my experience (arthritis), specialists typically won't take direct appointments without a referral. They don't want to triage the 90%, and most offices are booked weeks-to-months in advance...

IME, it’s highly dependent on region and specialty.

I can get into local dermatologists without problem. But an endocrinologist takes a referral (because there are so few, and they’re all fully booked).