Referrals

A referral 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 a referral 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 referral will indicate to both the patient and specialist that an appointment can be booked. An active, approved referral will indicate to both the patient and specialist that authorization was given and the appointment can be booked. This necessary step comes from member input and will decrease instances of members being billed for unapproved services.
• The Referral team will review your referral, 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 Referrals 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 referral notification will include:
    • Status of your referral (approval, denial, partial approval, etc.)
    • Limitations (number of visits, etc.)
    • Effective date
    • End date
• An approved referral represents authorization for a specific service or treatment over a defined period. We have extended the duration of most approved referrals to accommodate your needs, the availability of the specialty provider, and any scheduling delays or conflicts that may arise. Some approved referrals will now be active for as long as three years.
• We have also extended the duration of referrals for many tests and procedures to better reflect patient scheduling preferences and potential delays without seeking an updated referral.
• The details of the approved referral 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.

An approved referral (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 referral, reach out to your ordering provider.