Authorizations (Referrals)

An authorization to a specialist in our network (e.g., dermatology, cardiology, endoscopy) should start with your primary care provider (PCP) or a clinician Yale Health has authorized you to see.

• While an authorization from your PCP does not guarantee approval/authorization for the visit, care, or services, it's the starting point. An important update to the process: An active, approved authorization will indicate to both the patient and specialist that an appointment can be booked. An active, approved authorization will indicate to both the patient and specialist that the appointment can be booked. This necessary step comes from member input and will decrease instances of members being billed for unapproved services.
• The Authorizations team will review your authorization, and its status will be available to you in MyChart (if you do not have an active MyChart account, sign up here or watch for mailed notifications). You can always contact the Authorizations Department for an update on your referral and/or request a copy.
  • To View Your Referral Status in MyChart: Click Menu, scroll to Insurance, and click Referrals. All referrals will appear with details and status.
  • Your authorization notification will include:
    • Status of your authorization (approval, denial, partial approval, etc.)
    • Limitations (number of visits, etc.)
    • Effective date
    • End date
• Approved authorizations apply to a specific service or treatment over a defined period. We have extended the duration of most approved authorizations to accommodate your needs, the availability of the specialty provider, and any scheduling delays or conflicts that may arise. Some approved authorizations will now be active for an extended period of time.
• We have also extended the duration of authorizations for many tests and procedures to better reflect patient scheduling preferences and potential delays without seeking an updated authorization.
• The details of the approved authorization are shared with the provider to whom you are referred.
• For your convenience, we have created a new list of Yale Health’s in-network providers, vendors, and locations from which you can choose your appropriate service. We will keep this list up-to-date.

Prior authorization is required for all care outside of the Yale Health Center.

A referral from your PCP is also required before scheduling an appointment with the below departments within Yale Health Center:

• Allergy Department
• Dermatology
• Diagnostic Imaging
• Endoscopy
• Infusion
• Inpatient Care
• Laboratory Services
• Nutrition Counseling
• Physical Therapy
• Specialty Services

You do not need a referral from your PCP to schedule an appointment for these departments within Yale Health Center:

• Acute Care
• Behavioral Health/Mental Health & Counseling Departments
• Immunization
• Obstetrics & Gynecology
• Ophthalmology/Optometry/Eye Care Department
• Screening mammograms

If you need a new or updated authorization, reach out to your ordering provider.