New York University Skip to Content Skip to Search Skip to Navigation Skip to Sub Navigation

Referrals/Authorizations

Washington Square Students

Referral Requirements:

Referrals are required for services in Manhattan outside the Student Health Center.

Except for situations listed below, all students enrolled in a school-sponsored health insurance plan in need of medical care in Manhattan are required to first seek treatment and be evaluated at the SHC. If the evaluation by the SHC provider determines that the services are not available at the SHC, an off-site referral will be issued. Any copays or coinsurance fees incurred will be the responsibility of the student.

Services Exempt from Referral Requirement:

  • Medical Emergency Treatment in a Hospital*
  • Gynecological Care
  • Laboratory Tests
  • Maternity Care
  • Mental Health and Substance Abuse Services
  • Treatment for TMJ
  • When Student Health Center is closed and will remain closed for at least 24 hours.

*Referrals are required for follow-up visits after an emergency.

Referrals for Services Outside Manhattan

Students may use any provider outside the borough of Manhattan without an off-site referral from SHC. Any copays or coinsurance fees incurred will be the responsibility of the student.

We encourage students to first seek services by an SHC provider who will be able to supervise and coordinate care with minimal out-of-pocket expense for medically necessary treatment.

Students seeking care from providers outside the SHC should choose a provider who participates in the MagnaCare (NY/NJ area) or MultiPlan networks to ensure maximum benefits and reduce out-of-pocket expenses. To find a MagnaCare (NY/NJ area) or MultiPlan provider go to www.chpstudent.com or call (877) 373-1170 and a CHP representative will assist you in locating a participating provider. Any copays or coinsurance fees incurred will be the responsibility of the student.

Referral Limitations:

Important: A referral cannot be granted after services have been rendered.

  • The referral is only valid for treatment of a specific condition for the period of time stated on the referral.
  • The referral may also limit the number of visits allowed within that time frame.
  • The condition must be re-evaluated by the SHC healthcare provider once the limits of the referral have been reached.

Pre-Certification/Authorization

The school-sponsored health insurance plans require Pre-Certification/Authorization for certain out-patient and in-patient services. Hines Associates Inc., administers the Pre-Certification/Authorization process for the plans. To contact Hines Associates, call (866) 327-4520.

Pre-Certification Requirement

Out-Patient Services:

  • Surgical procedures performed in an outpatient facility or ambulatory surgical center that require general anesthesia;
  • Intensive outpatient programs for biologically based mental illness/serious emotional disturbances or mental or nervous disorders;
  • Private duty nursing services performed when the covered person is not confined to a hospital
  • Home birth or admission to a birthing center;
  • Home health care

In-Patient Services:

  • All inpatient admissions, including length of stay to a hospital, convalescent facility, skilled nursing facility, substance abuse facility, residential treatment facility, or inpatient hospice.
  • All partial hospitalization in a hospital, residential treatment facility or facility established primarily for the treatment of substance abuse.
  • All inpatient maternity care, after the initial 48/96 hours.

If pre-certification is not secured, eligible expenses will be subject to a $500 per admission or out-patient service deductible in addition to any applicable co-pays or co-insurance.

Authorization Requirement:

Physical Therapy treatment plans must be authorized to continue treatment after the initial 12 visits.

Emergencies
Appointments
Student Feedback
logolink
NYU Footer