If you live in Milwaukee or Southeastern Wisconsin and have been told you have high blood pressure, diabetes, or signs of kidney strain, it may be time to see a nephrologist. However, many patients are unsure how to start that process, especially when a referral from a primary care provider is required.
At Midwest Nephrology Associates, we regularly see patients delayed in receiving specialized kidney care due to issues with the referral process. We want to help clarify how to move forward if you're in that position.
Why Referrals Matter in Wisconsin
Most insurance providers in Wisconsin, especially HMO and PPO plans, require a referral before covering specialist visits. This includes seeing a nephrologist. Without this referral, you may either be denied the appointment or be responsible for the full cost of the visit.
In Milwaukee and throughout Southeastern Wisconsin, healthcare systems are often network-driven, meaning referrals keep your care coordinated and covered under your insurance plan.
Common Reasons Patients Don’t Get Referred
- The topic doesn't come up during routine checkups
- Labs are abnormal but not yet alarming, so your doctor decides to monitor first
- Patients feel unsure how to raise the concern
- Insurance requirements are misunderstood, even by staff
The result? Patients delay nephrology care, even when early intervention could help preserve kidney function or slow progression.
What to Do If Your Primary Care Provider Does Not Offer a Referral
If you believe you need to see a kidney specialist but your primary care doctor has not initiated the referral, here’s what you can do:
- Review your lab results. Look for notes about elevated creatinine, blood or protein in your urine, or a reduced eGFR. These are all signs that nephrology care may be needed.
- Bring your concerns to your provider. At your next visit, you can say something like:
“I noticed that my labs showed some kidney concerns. I’d like to be proactive and talk about seeing a nephrologist. Can we discuss that?” - Ask about long-term management. If you have high blood pressure or diabetes, you can ask:
“Since these conditions can affect my kidneys, do you think it makes sense to get a nephrology consult?” - Refer to guidelines. Mention that early kidney care can prevent hospitalizations and help manage medication more effectively. You might say:
“I’ve been reading that early referrals can improve outcomes. I’d like to get ahead of any potential issues.”
If you’re still not offered a referral, remember that you can call your insurance provider directly to ask about seeing a specialist<. Some plans will allow you to self-refer after completing certain steps.
When a Referral is Urgent
Referrals are especially important if you have:
- Chronic kidney disease (CKD), even in early stages
- Uncontrolled hypertension or diabetes
- Protein or blood in your urine
- A family history of kidney disease
- Swelling in your legs or face without a clear cause
If any of these apply to you, ask your provider for a referral or reach out to us to discuss next steps.
We're Here to Help
At Midwest Nephrology Associates, we work closely with primary care offices across Milwaukee, Waukesha, Racine, and surrounding areas to ensure patients receive timely kidney care. We also help patients understand their insurance, including whether a referral is needed and how to obtain one.
Use our Insurance Guide to verify your plan's referral requirements, or visit our Referral Criteria page to see if you may qualify for specialty care.
Take the Next Step
If you’re unsure where to begin, contact us today. We can help guide you through the process, whether you're in Milwaukee, Waukesha, or another part of Southeastern Wisconsin.