Referrals to Specialists

What is a referral in Switzerland?

A referral (Überweisung, référence médicale) is a document or formal instruction from your GP authorising you to see a specialist. It serves two purposes: it tells the specialist the clinical reason for your visit, and it signals to your insurer that the specialist consultation is medically justified and should be covered.

In Switzerland, a referral is not just a courtesy — in gated insurance models, it is a financial and contractual requirement. Without it, your insurer may refuse to reimburse the specialist's fee.

When do you need a referral?

This depends entirely on your insurance model:

• Standard model: No referral required. You can book directly with any specialist covered by KVG. Your insurer cannot refuse coverage based on the absence of a referral. However, even on Standard, a GP referral helps: specialists prioritise patients sent by a GP, and the referral letter gives the specialist immediate context.
• Hausarzt model: Your designated GP must be your first point of contact for all non-emergency issues. You need a referral before seeing any specialist (exceptions below).
• HMO model: Same as Hausarzt — your HMO GP or practice acts as the gatekeeper. In fully integrated HMO systems, the specialist may be in the same building, but the referral process still applies internally.
• Telmed model: You must call the insurer's medical hotline first. They decide whether a specialist is warranted and can issue a referral or direct you to a practice. Bypassing the hotline means the visit may not be covered.
• Network model: Referrals stay within the network. Your GP can only refer you to network specialists. If you want to see a specialist outside the network, the cost is not covered.

Exceptions — when you can go directly to a specialist

Even in gated models, certain specialist categories are exempt from the referral requirement. These are consistent across most insurers:

• Gynaecologists: Women can see a gynaecologist directly without a GP referral, regardless of insurance model.
• Ophthalmologists: Eye examinations are generally accessible without referral.
• Paediatricians: Children can be taken directly to a paediatrician without going through a general GP.
• Chiropractors: Direct access is permitted in most models.
• Emergencies: If you need emergency care, you go directly to an emergency department or call 144. The insurer cannot deny coverage because you skipped the GP in a genuine emergency.
• Psychiatrists: Since 2022, psychiatrists can be accessed directly without a GP referral under KVG.

How to request a referral from your GP

Referrals are issued at GP appointments. You cannot usually get a referral by email or phone — the GP needs to assess your condition in person before sending you to a specialist. At the appointment:

1. Describe your symptoms clearly. The more specific you are, the more targeted the referral will be.
2. Ask specifically which type of specialist they are referring you to — for example, a rheumatologist, neurologist, or cardiologist.
3. Ask whether you are being referred to a specific doctor (named referral) or whether you can choose any covered specialist.
4. Confirm whether the referral letter will be given to you directly or sent electronically to the specialist.

In most practices, the referral letter (Überweisungsbrief) is either handed to you immediately, sent to the specialist's office, or delivered via secure medical communication platforms. Keep a copy for your own records.

What the referral letter contains

A Swiss referral letter typically includes:

• Your name and date of birth
• Your diagnosis or presenting complaints (in ICD-10 codes plus plain language)
• Relevant history, test results, and current medications
• The reason for referral and the specific question the GP wants the specialist to answer
• The GP's name, address, and contact details

This letter is important. When you arrive at the specialist, hand it to reception and make sure it is scanned into your file. The specialist's response will typically go back to your GP, who will then discuss findings with you.

Waiting times

Specialist waiting times in Switzerland vary significantly. Common specialties (dermatology, ophthalmology, orthopaedics) can have waits of several weeks to months, especially in urban centres where demand is high. Your GP can advise on urgency and may mark the referral as urgent if clinically warranted, which can speed up the process.

If your GP marks the referral as urgent (dringend), contact the specialist's office directly and mention this. Many practices keep emergency slots for urgent referrals.

Referrals in emergencies

If your condition deteriorates acutely, do not wait for a referral. Call 144 (emergency ambulance) or go directly to the nearest hospital emergency department. Insurance coverage applies in genuine emergencies regardless of whether a GP referral was obtained first.