Which specialists you can see directly, without a referral

Yes, you can reach certain specialists directly, without a referral from your family doctor — including when you want the visit to be covered by the Casa de Asigurări de Sănătate (CAS, the health insurance house). Still, the general rule remains the referral: for most outpatient specialist consultations you need a referral issued by the family doctor or another specialist. The exceptions — the direct access situations — are expressly provided for in the framework contract and its implementing rules (a joint order of the Ministry of Health and CNAS).

Below you’ll find the list of situations in which you can go straight to a specialist, and what happens otherwise, if you turn up without a referral.

The general rule: the referral

In the public system, the referral is the “key” that makes a specialist consultation paid for by CAS. It is issued by the family doctor you are enrolled with or by another specialist doctor under contract with the insurance house. Without a referral, in ordinary situations, the consultation is not covered — you can have it, but at your own expense.

The referral has a clear purpose: the family doctor steers you toward the right specialty and avoids unnecessary referrals. That’s why the exceptions to this rule are limited and well defined.

The situations where you go DIRECTLY (and it’s covered)

1. Medical-surgical emergencies

In a medical-surgical emergency you don’t need any referral. You can present yourself directly at the on-call room, the UPU/CPU (emergency department), or a specialist, and the service is provided regardless of whether you are insured. The emergency always takes precedence over formalities.

2. Diseases with endemic-epidemic potential

Communicable conditions requiring isolation, treatment, or reporting (diseases with endemic-epidemic potential) allow you to present directly to a specialist. The reasoning is public health: here the speed of diagnosis matters.

3. Family planning

Certain family planning services can be accessed directly, without a referral from the family doctor.

4. Mental health

Some mental health services can be accessed directly, usually through the mental health centres (CSM) that cover your area. Direct access matters a great deal in psychiatric situations.

5. Dental medicine

For the dentist you don’t need a referral. You go directly to a practice under contract with CAS, and services in the basic package are covered up to the monthly cap.

6. Monitoring of certain chronic diseases

Patients with certain chronic diseases, already on record with a specialist according to the framework contract list (often detailed in a dedicated annex — check the exact annex number for the current year), can continue their monitoring with the specialist without going through the family doctor each time for a new referral.

7. The consultation with your family doctor

It may seem obvious, but it’s worth saying: you don’t need a referral for your own family doctor. They are your entry point into the system and, for many problems, can resolve your situation without referring you further.

What “direct access” actually means

Direct access means you can book and be seen by the specialist without a referral, and the service remains covered by CAS, if you are insured and the practice is under contract with the house. It does not mean that any consultation is free anywhere: outside these situations, the referral rule applies.

Note: even in the cases above, the specialist may ask you for earlier medical documents (medical letters, test results) to assess your situation correctly.

No referral, but you still want a specialist? You pay

If you don’t fall within the exceptions and don’t have a referral, you can go to a specialist, but you pay for the consultation — either at a private practice or at one that also offers paid services. Sometimes, if the waiting time for a covered appointment is long, people choose to pay for a first private consultation, then return to the covered system with the referral they’ve obtained.

How long a referral is valid

Usually, a referral for clinical specialties has a limited validity (typically 30 days from issue for presenting to the specialist; for chronic conditions, the period can be longer). The deadlines can change through the framework contract, so check the validity noted on the referral itself.

How to check for your own situation

The exact lists of direct-access services and the annex numbers are updated annually. Before you book:

• ask the practice whether the service you need is provided without a referral in your case;
• check on cnas.ro the framework contract and the rules in force for the current year;
• confirm that you are insured and that the facility has a contract with the insurance house.

The rule is simple to remember: if you’re not in one of the situations above, start from the family doctor for a referral — you’ll save both time and money.

Sources

• The framework contract on the conditions for providing medical care within the social health insurance system and its methodological implementing rules (a joint order of the Ministry of Health and CNAS) — cnas.ro
• Casa Națională de Asigurări de Sănătate (CNAS, the National Health Insurance House) — cnas.ro
• Casa de Asigurări de Sănătate Cluj (Cluj Health Insurance House) — cascj.ro