Referrals to Specialists

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

You may want to contact your insurance company before your visit to check whether you need a referral and whether the cost of the visit will be covered by your insurance plan. Many insurance plans do not cover the cost of visits to specialists.

Payment for Visits to Specialists

The method of payment for visits to specialists will depend on the individual physician's office and 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. Do not assume the physician's office is knowledgeable about your insurance coverage. It is a good idea to verify your coverage with your insurance company before receiving services.

INSURANCE COVERAGE

For students covered by Blue Cross Blue Shield (BC/BS) through UHS:

Office visits to specialists in Monroe County are covered up to $500 per specialty per calendar year, with a $10 co-payment at the time of the visit. A referral by a UHS health care provider is required before the visit. Visits to specialists outside Monroe County are not covered. You should take a printed copy of the referral from your provider with you to the specialist's office. UHS will fax over a copy of the form to the specialist as a back-up.

There is a separate charge for diagnostic laboratory tests or other procedures performed during a visit to a specialist. Coverage for these services is not included in the coverage for visits to specialists. Charges billed by a hospital or UHS are covered in full. Charges that are billed by a private physician's office or lab are covered up to 80% of the cost; you must pay the remaining 20%.

Some procedures and tests (e.g., allergy skin tests/patch tests) are not covered by this insurance plan. Services excluded from coverage are listed on the last page of the BC/BS Summary of Benefit, which is available on the UHS web site (www.rochester.edu/uhs) in “Health Insurance for Full-time Students.”

We encourage you to speak with the UHS Insurance Advisor to confirm your insurance coverage and ask questions about coverage. She can explain your insurance coverage and assist you in filing a claim. She can be reached at insurance@uhs.rochester.edu or 585-275-2637. Her office will be located in the new University Health Service Building on the River Campus.

For patients on other insurance plans (i.e., not the UR Student BC/BS Insurance):

You can contact your insurance company to check if the cost of visits and/or associated tests and procedures is covered by your plan. If the charges are not covered, you are responsible for paying the bill.

For Questions About Billing & Insurance

Students can contact the UHS Insurance Advisor at insurance@uhs.rochester.edu or 585-275-2637.

All other UHS patients can contact the UHS Billing Specialist at klock@uhs.rochester.edu or 585-275-2638.