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University Health Service
Office of the Provost

Referrals to Specialists

If your UHS primary care provider (physician or nurse practitioner) considers an evaluation by a specialist is necessary, you will be referred to one. If transportation is a problem for you, please mention this to your provider so they can refer you to someone in the vicinity of the University.

You may want to contact your insurance company before your visit with the specialist to check whether you need a referral and if the cost of the visit will be covered by your insurance plan.

Payment for Visits to Specialists

The method of payment for visits to specialists depends on the individual physician’s office and its billing practices. You may be expected to pay the bill yourself, or you may be able to provide the physician’s office with your insurance contract number so the claim can be submitted directly. If your insurance plan requires a co-payment for visits to specialists, you will be expected to pay the co-payment at the time of your visit. We recommend checking with the physician’s office about payment when you schedule your appointment.

Laboratory Tests & Procedures

If you have diagnostic laboratory tests or other procedures (e.g., wart removal, biopsies, Pap smear, surgical procedures) performed during your visit, you will be charged separately for these procedures. We encourage you to verify your coverage with your insurance company before receiving services.

Insurance Coverage

For students covered by the UR Student Health Insurance Plan (Aetna) through UHS:

  • Office visits to specialists require a $25 co-pay per visit. A referral by a UHS health care provider is required before the visit.
  • Urgent care visits require a $50 co-pay per visit. A referral by a UHS health care provider is required before the visit.
  • Emergency Department visits require a $100 co-pay per visit. This copay is waived if the visit results in hospital admission. A referral by a UHS health care provider is required before the visit, or as soon as reasonably possible after the fact.
  • There may be a separate charge for diagnostic laboratory tests, imaging, or other procedures performed during a visit to one of the outside providers listed above and separate cost sharing may apply. Diagnostic labs and imaging services billed by a private physician’s office, hospital, or UHS are covered in full when performed by an in-network provider with a referral. Diagnostic labs and imaging services billed by a non-participating provider or without a referral are covered up to 70% of the cost; you must pay any remaining balance. Some procedures and tests (e.g., allergy skin tests/patch tests) are not covered by this insurance plan. Services excluded from coverage are listed in the University of Rochester Plan Design and Benefits Summary.
  • Please note that referrals must be obtained from your UHS provider and must be renewed each plan year. To request a referral renewal, please contact your UHS provider via UHSConnect or call 585-276-7349.
  • We encourage you to speak with a UHS Insurance Advisor to confirm your insurance coverage and to ask questions about coverage. The UHS Insurance Advisors can be reached at insurance@uhs.rochester.edu or 585-275-2637. Their offices are located on the second floor of the UHS Building on the River Campus.
  • Coverage for all services is based on medical necessity. Medical necessity is determined by Aetna, based on information provided by the billing provider and all relevant clinical policy bulletins.

For patients on other insurance plans (i.e., not the UR Student Health Insurance Plan):

  • We recommend contacting your insurance company to check if the cost of visits and/or associated tests and procedures will be covered by your plan.
  • If the charges are not covered, you are responsible for paying the bill.

Billing & Insurance Questions