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If you have halfway decent insurance in the US you do not need a referral to see a specialist.

The exception to this rule is if you are in an HMO like Kaiser which force you through "level one support" (your GP) or if the specialist is so busy they require a referral to screen out the social media schizos.

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However, many (most?) specialists won't see you without a referral unless they are self pay.
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Whether you need a referral typically depends on your insurance plan, not the doctor you want to see.
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Yes. They don't have time to deal with hypochondriacs who just show up. Unless you are an existing patient asking for followup, or have a referral, many will not schedule you or will maybe give you an appointent six months from now.
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