Referral Requirements

If you are enrolled in the Columbia University Student Health Insurance Plan, your primary care provider is your Columbia Health Medical Services clinician and your initial mental health provider is at Counseling and Psychological Services.

Except for visits to a hospital emergency room or an urgent care facility, referrals for off-campus care are mandatory from your Medical Services or Counseling and Psychological Services provider. Providers at Medical Services and Counseling and Psychological Services offer referrals after evaluation and treatment has been completed and as the need for outside services is clinically indicated.

When a Referral Is Required

  • Students do not need separate referrals each time they see the same provider for an ongoing condition. However, referrals for medical conditions terminate on the last day of each plan year (August 14, 2018 for the 2017-18 plan year). Students should schedule an appointment with their Columbia Health provider to determine if a referral for continued treatment is indicated. Referrals for mental health conditions for off-campus counseling and psychiatric services are valid as long as students remain continuously insured by the Columbia Student Health Insurance Plan.
     
  • Off-campus medical services for a spouse or domestic partner (off-campus mental health services do not require a referral for spouses/partners)
     
  • If students are injured or become ill while traveling or spending an extended time away from Columbia, they will need to call and speak with their Columbia Health primary care provider to determine what kind of treatment is appropriate.
     
  • Students may need a referral from their on-campus provider in advance of seeing an off-campus provider.

Even with a referral, students will be responsible for copays and possible additional charges when seeing an off-campus consulting provider.

No Referral Required

A referral is not required under the following conditions, though Columbia Health providers can assist in finding appropriate services:

  • When students are not in New York City, they will be covered for primary care, as well as other services, by the Aetna network of providers. If students are 50 miles or more away from Columbia Health on the Morningside campus, a referral will not be required.
     
  • After emergency medical conditions, students must return to Columbia Health for necessary follow-up care.
     
  • Medical care obtained 50 miles or more away from the Morningside campus
     
  • Prenatal and obstetrical care
     
  • Elective termination of pregnancy
     
  • Dependent children (all services)
     
  • Mental health services for a spouse or domestic partner (off-campus medical services require referrals)
     
  • One baseline mammogram for women aged 35-40, one per year thereafter for women age 40 and older. Coverage will be provided more frequently if recommended by a clinician for a covered person who has a prior history of breast cancer or who has a first-degree relative with a prior history of breast cancer.
     
  • One annual routine Pap smear screening and office visit; Pap smear screenings and women’s health care visits are available on campus where a student pays no copay or deductible, and all associated laboratory tests are covered. If additional appropriate testing is performed as part of an off-campus annual office visit, benefits for the testing will be payable in accordance with the plan's policy, and the student may be responsible for a portion of the laboratory testing. No referral will be needed.