If you need specialty care or testing services, please start with your primary care team. They will help you get the care you need. This includes making a referral to a specialist, sharing your medical record, and working with you and your other doctors to monitor your health.
Many patients have questions about referrals - like how to get an appointment or who to call. Here are some answers to help better understand the process:
Frequently Asked Questions
I have a health need that requires specialty care or testing. What should I do?
Start by talking to your primary care team. In many cases, they can treat you over the phone or with a simple office visit. Otherwise, they will refer you to the right service for your needs.
Where will my CHA doctor send me for specialty care?
In order to give you the most coordinated care, we try to make referrals within our network. CHA has excellent surgeons and specialists at our hospitals. For highly complex cases, we usually send patients to our partners at Beth Israel Deaconess Medical Center or Massachusetts General Hospital for Children.
What if I want to use a specialist or service outside CHA?
Start with your CHA primary care team. Health care works best when you have ONE TEAM working for you. This leads to high quality, coordinated care.
There are many doctors in your health plan network who are outside the CHA referral network. Many outside doctors do not share information easily and we cannot ensure the quality of their services.
As a result, your primary care team may not have all the necessary information to give you the best care.
Can I get a referral from my primary care doctor after I see a specialist?
Usually no. Please request a referral BEFORE you see a specialist or have tests.
Many times your primary care team may want to see you before making a referral. In addition, many health plans require a referral ahead of time. Without a referral, you may have to pay for all the costs of the visit (not just the co-payment or deductible).
What if I have a question about a referral?
Please call your CHA primary care center directly. For non-urgent questions, you can also send a MyChart message. If you need to know what services are covered by your health plan, contact your plan’s Member Services team. The phone number is on your insurance card.
What if I haven’t seen my primary care doctor in a while or I am new to CHA?
Your CHA doctor may want to see you before granting a referral and/or prescription renewal. This will let them evaluate your health and better direct your care. This more important if you haven’t had a recent visit with your CHA primary care center.
What if I am referred to a specialist when I am in the emergency room or the hospital?
If possible, please use a CHA hospital for your emergency. We have 24-hour emergency care for all ages at Cambridge Hospital, Somerville Hospital and Everett Hospital.
If you visit an emergency room at a hospital that is not part of CHA, you may see a non-CHA specialist as part of your care. You may also get a follow-up referral to that hospital. When your emergency is over, please call your CHA primary care team right away. This way they will know how you are feeling and can connect you to a specialist in the CHA network.
Does my health plan (insurance) have any rules about referrals?
Most do. These vary by the company and type of coverage. For example, in some plans, getting care from certain doctors (in network) can save you money.
Plans like HMOs require that your primary care doctor choose a specialist for you. Plans with preferred provider (PPO) or point of service (POS) options may make you pay more to see a specialist that your doctor did not select. Other plans may make you pay the entire bill (not just a co-pay or deductible) if you see a doctor outside their network. If you have questions, please call your health plan’s Member Services.
What if I need a referral when I am on vacation or out of town?
We hope you never need specialty care when you are away. But if you do, please check with your health plan. Your insurance may have different rules about out-of-area medical services.
Your Choices for Specialty Care
Stay at CHA. You will find great doctors and testing for most health needs right here. You will also receive coordinated care, which has been shown to lead to better health outcomes. And if you are a MyChart user, you can see your test results and ask questions through our secure system.
Using a CHA Specialty Partner. If the services you need are not available at CHA, we will find care for you within the CHA family. Our specialty partners work closely with your doctor and care team to understand your health and meet your needs.
Doctors and Services Outside the CHA Network. Not every specialist in your health plan network is connected with CHA, and most don’t share information easily with us. So when you go outside CHA, it is hard for us to ensure the quality of your care or make sure you get the support you need. It is also difficult for us to answer your questions about visits outside of CHA.