Specialty Care Coordination & Referrals
If you believe you need to see a specialist, your first step is to make an appointment with a primary care provider at Student Health.
All specialty-care visits need to be pre-authorized by a Student Health provider. If a specialty-care visit is not pre-authorized, your insurance will not cover it. This applies to specialty-care follow-up visits as well.
One exception to this rule is if you are referred to a specialist from an ER or Urgent Care visit. In this case, it’s possible to get retro-authorization from Student Health. Please see ER/Urgent Care Claims for more information.
Common specialty care referrals include:
|Breast Health Center||OB/GYN|
When you are referred to a healthcare provider outside of SHCS, follow the steps below:
Step 1: Bring Your Referral to Your Appointment
Bring your referral and your Anthem ID card to your appointment with the specialist. Your appointment may be cancelled if you arrive without it.
Step 2: Give the Specialist Your Insurance Card
Give the specialist’s office your insurance card. If Steps 1 was done correctly, billing issues should not arise. If billing issues arise, please review the Medical Billing Process.
If the specialist does not bill the insurance company directly, then you will need to get reimbursed by the insurance company by completing the Medical Claim Reimbursement Form. In this case, make a copy of your receipt and itemized bill, complete a claim form, and mail both to Anthem at P.O. Box 60007, Los Angeles, CA 90060-0007. If billing issues arise, please review the Medical Billing Process.
Step 3: Get Follow-up Appointments Authorized
Get any follow-up visits authorized. If your specialist requests follow-up visits or a referral to another specialist, make sure to ask the specialist’s office to fax SHCS the request(s) for authorization. Your specialist should also fax over any applicable doctor notes from your visit. Requests not authorized by SHCS will not be covered.
All specialty care requires a $20 co-payment per visit, and some visits require that you meet your annual deductible of $200 and pay a co-insurance fee. See Medical Billing Process for more information.
Your annual policy deductible and co-insurance are waived if you are referred to a UCSF specialist per the memorandum of agreement between SHCS and UCSF Medical Center. Please call UCSF Patient Financial Services at 1-866-433-4035 if you are being billed.