Frequently Asked Questions

The referral may be generated and approved within the department and a copy of the approved referral given to you while you are there.

Some referrals require further medical review. These referrals are pended for review by the Referral Coordination Department. If the referral is pended, the referral is reviewed and additional information may be needed prior to approval.

You must contact your primary care clinician (PCC) department.  Your PCC can order these services if they are needed.

Yes.  The time period and services authorized are communicated to the provider to whom you are referred.  You can contact the Referral Coordination Department for a copy of your authorization with details.

A referral covers only the specific services requested on the form by your Yale Health clinician. If the outside clinician feels you need additional consultations, treatments, or testing, that clinician must contact the referring Yale Health clinician to have a new referral generated for additional services. Make sure to check with your clinician or the Referral Coordination Department at 203-432-7397 to assure that another referral has been initiated and approved before additional services are rendered.

Yes. Referrals to the Specialty Services Department are for a specific problem identified by a primary care clinician (PCC).  The PCC sends the referral electronically to Specialty Services who will contact you with the appointment date and time options. Yale Health clinicians refer patients utilizing our clinical guidelines. All new, non-emergency appointments are scheduled within four weeks.

You do not need a referral to use a primary care clinician (including those in the Ob/Gyn and Athletic Medicine Departments) or to use the Acute Care or Mental Health & Counseling Departments. Some services available to you under Yale Health Basic coverage do require a referral from your primary care clinician. These include nutritional counseling and laboratory services.

You need an in-house referral if your primary care clinician refers you to specialist within 55 Lock Street. If you are are referred outside of 55 Lock Street for any services—office visits, treatments, tests, consultations—you need an outpatient referral.

No referrals are needed for the use of fee-for-service departments.

Yale Health members do not need referrals for screening mammograms and may call the Yale Breast Center directly at 203-688-1010 to schedule an appointment. However, please give the mammography center your primary care clinician's or Ob/Gyn clinician's name so your results can be forwarded to them.  If Yale Health is not your primary insurance, please verify coverage and the need for a referral with your primary insurance company.         

Diagnostic mammograms require that an order from your clinician be sent to the Yale Mammography Center.  If you require a diagnostic mammogram, please contact your primary care clinician. 

No.  You may contact the nutritionist directly via phone at 203-432-0093 or e-mail.

Nutrition consultations are appropriate for those who would benefit from individualization of diet recommendations due to medical concerns. Examples of this are people who have diabetes, high cholesterol levels or other abnormal lipid patterns, or impaired fasting glucose. Those people who are overweight or obese with other medical concerns such as hypertension may also benefit from a more individualized approach to meal planning.

No.  Yale Health members may call Magellan directly at 800-327-9240, TDD 800-456-4006 to access mental health/behavioral health services. 

A referral is the process by which Magellan provides you the name and contact information of a mental health provider for the purposes of diagnosis or treatment.

If you requested that Magellan give you the names of several providers, it is important to call Magellan back to let them know the name of the provider that you have selected. Magellan will then authorize the care.

Although your clinician may have discussed a treatment, you must receive a referral and have prior approval in order for the treatment to be covered. If you obtain treatment without a referral and prior approval, the claim will not be paid. The same applies if you want a second opinion.

Check to make sure that what you received is actually a bill. It may have been a copy of their invoice describing the procedure and telling you that the claim has been sent to Yale Health for payment. If it is a bill, contact the Claims Department at 203-432-0250.

No.  When referred out to another provider, you must come back to Yale Health for follow up care.