Referrals
A referral to a specialist in our network (e.g., dermatology, cardiology, endoscopy) should start with your primary care provider (PCP).
- 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. 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 you will receive a newly revised letter about its status in the mail. You can always contact the Referrals Department for an update on your referral and/or request a copy.
- An approved referral authorizes payment 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.
Additionally…
- You may now quickly review the status of an active referral and its expiration date in your MyChart account:
In MyChart, click Menu, scroll to Insurance, and click Referrals. All referrals will appear with details and status.
An approved referral (prior authorization) is required for:
- All care outside of the 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 for these services if rendered at the Yale Health Center:
- Acute Care
- Behavioral Health/Mental Health & Counseling Departments
- Immunization
- Obstetrics & Gynecology
- Ophthalmology/Optometry/Eye Care Department
- Screening mammograms
You may also receive a referral from a provider Yale Health has authorized you to see.
Referrals authorize services for a specific service and time. The referral details are communicated to the provider to whom you are referred. You will receive a notification about the status of your referral in the mail. You can also contact the Referrals Department for a copy of your referral.
Your referral notification will include:
- Status of your referral (approval, denial, partial approval, etc.)
- Limitations (number of visits, etc.)
- Effective date
- End date
If you need a new referral, contact the ordering provider.
