Member Update - February 2024

Specialty Services and Other Referrals

This Member Update focuses on enhancements to our referral process for specialty care services.

We hear you: Based on member feedback, we recently enhanced our referral process and would like to share an overview of the new steps to follow if your provider refers you for specialty care or services. We appreciate your input and hope these process enhancements will bring an improved experience for you at Yale Health.

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 be the indicator to both 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 the status of your referral in the mail. You can always contact the Referrals Department for an update on your referral and/or to request a copy of it.
• An approved referral authorizes payment for a specific service or treatment over a defined period of time. We have extended the duration of most approved referrals to accommodate your needs and the availability of the specialty provider, as well as 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 having to seek 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 for you to choose your appropriate service from. We will keep this list up-to-date for you.

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, click Referrals. All referrals will appear with details and status.

• Our Referrals and Claims department has grown in size to meet our growing needs and improve our member experience, including response time and phone access.
• We have upgraded our Call Center’s phone system to offer improved telephone service. More on our new phone platform in our next Member Update.