• Affiliated With

    • Beth Israel Deaconess Medical Center
    • MassGeneral Hospital for Children
    • Harvard Medical School Teaching Hospital

About Referrals

Many patients have questions about what to do when they are sick, how to get a specialty referral or how to renew a prescription. Here are some answers to help better understand the process:


Frequently Asked Questions

I am feeling sick and think I need to see a doctor. What should I do?

Please call your CHA Primary Care Center anytime (day or night) to talk to our medical staff. Your care team is available 24/7. They know you best and are here to help.

If your health issue is not treatable by phone, you can almost always get a same or next day office visit.

I'm having an emergency that can't wait. What should I do?

If you need emergency care or are asked to go to the hospital by our medical staff, you can come to CHA. You will find 24-hour care at CHA hospitals in Cambridge, Somerville and Everett.

CHA hospitals have the shortest ER wait times in Massachusetts (6 minutes on average) and when you use CHA for emergency care, your care team will know about your health and any medicines you were given. This is safer for you and important to us.

For life threatening needs, don't wait. Call 911 or go right to the closest emergency room.

How do I renew a prescription at CHA?

If you need to renew a prescription, please contact your primary care center by phone or MyCHArt. Your doctor may want to see you first, based on your medical history and symptoms.
 

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, our policy is to refer patients within CHA for specialty care whenever possible. This gives you coordinated care and allows your caregivers to work together closely.

CHA has excellent specialists and testing services. This includes board-certified doctors who trained at some of the nation's best hospitals, and services like CT, MRI, Mammography and Cardio-Pulmonary testing.

For highly complex health needs, we may refer you or your family member to see a doctor at one of our partner hospitals, Beth Israel Deaconess Medical Center (BIDMC) or Massachusetts General Hospital for Children (MGHfC).

What if I want to use a specialist or service outside CHA?

Please talk to your CHA primary care team first. Health care works best when you have ONE TEAM working for you.

There are many doctors in your health plan network who are outside of the CHA referral network. Many outside doctors do not share information easily and we cannot ensure the quality of their services.

Can I get a referral from my primary care doctor after I see a specialist or have a test?

No. Please request a referral BEFORE you see a specialist or have tests. Your primary care team may want to see you before making a referral.

You should also be aware of any costs involved. Many health plans require a referral ahead of time. Without this, you may have to pay all the visit costs (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, please contact your plan's Member Services team. The phone number is on your insurance card.

If my referral request is denied, what can I do?

Cambridge Health Alliance (CHA) is part of a provider organization that is certified as a "risk-bearing provider organization" (RBPO) by the Massachusetts Division of Insurance. An RBPO is a group of health care providers that work together to coordinate your care and enter into financial agreements with insurance companies to do so. CHA is participating in an RBPO that is called the CHA Accountable Care Organization (ACO).

Per regulatory guidelines and as part of CHA's commitment to our patients, we have established a process for you or your authorized representative (such as a spouse, family member, friend, attorney or legal guardian) to make a complaint about issues like referrals, timely access to treatment or services or other concerns about limitations of care.

To ask about this appeals process or to file a complaint, please contact our Patient Relations Department.

You can contact our Patient Relations Department in the following ways:
To file a complaint by phone: 617-665-1398

To file a complaint in writing:

Cambridge Health Alliance
Patient Relations Department
1493 Cambridge Street
Cambridge, MA 02139
Fax: 617-591-4490

To file a complaint online: Click on "Contact Us" in our main navigation and fill out our contact form. Or send an email directly to webmaster@challiance.org.

We will give you a written answer to your pre-service and post-service complaint/appeals in fourteen (14) business days. If your complaint involves urgent medical needs, we will give you a written answer in three (3) days.

For more information or questions, call 617-665-1398.

For more information on your right to make a complaint, contact the Massachusetts Office of Patient Protection at 800-436-7757.

What if I haven’t seen my primary care doctor in a while or am new to CHA?

Your CHA doctor may want to see you before granting a referral. This will let them evaluate your health and better direct your care. This more important if you are a new patient or haven’t had a recent visit at 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 CHA Cambridge Hospital, CHA Somerville Hospital and CHA 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. They will want to 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 you can save money by seeing certain doctors (in network).

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.