Except for emergency and urgent care as defined in the Employee Coverage Booklet or Student Handbook, healthcare services outside of Yale Health Center require prior authorization by Yale Health.
Prior authorization may be requested in one of two ways:
- Most referrals start with your primary care provider (PCP). A referral from your PCP does not guarantee authorization. Your referral will be reviewed and you will be notified of the status.
- You may also receive a referral from a provider Yale Health has authorized you to see.
If an outside specialist refers you to another outside specialist, you must have prior authorization from Yale Health for those services to be covered.
If you need lab testing ordered by an outside specialist or other healthcare provider, the lab test must be performed at a Quest Diagnostics location in the six New England states (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont) unless prior authorization is given by Yale Health.
If you need diagnostic imaging ordered by an outside specialist or other healthcare provider, all imaging including CT scan, x-ray, ultrasound, and MRI, must be performed at the Yale Health Center unless prior authorization is given by Yale Health.