Referrals for Specialty Care

If you are seen at Vaden for a (medical) Primary Care service, and the clinician determines that you should see a specialist, a medical referral will be created for you. A medical referral is a written order from your primary care doctor/provider to see a specialist for a specific medical service. Medical referrals serve multiple purposes: they may be initiated to ‘open the door’ for securing an appointment with a specialist (in many instances, specialists will not accept patients unless they are referred by a provider who is knowledgeable about them) and/or they may be used to convey information about you so the specialist knows why you are coming.

Referral Information

If you are enrolled in Cardinal Care, you will need a referral from a Vaden provider in order to access (medical) specialist care through Stanford Health Care, Menlo Medical Clinic, Sutter Health, or any provider within 25 miles of Stanford. See a listing of services which do not require referral below. We highly encourage students who are enrolled in Cardinal Care to first seek care from a Vaden provider and then work with that provider to access specialty care if it is needed. The Vaden Health Insurance and Referral Office team will process the referral (i.e., gather and forward information required) in one business day if ‘stat’ or ‘urgent’ and in two to three business days if ‘routine.’ Students are notified by secure message when this step has been completed. Typically, the referral is received by a referral center, and once that has occurred, the referral is distributed to the appropriate specialty clinic. Note: this distribution can take several days. In some instances the specialty clinic will contact the student regarding an appointment and in others the student must contact the specialty clinic to make the appointment. For certain specialties, available appointments can be weeks out (or even longer). Should this be true, you may need to consider another option in the area.

To search for a Wellfleet Student participating network provider (doctor, hospital, pharmacy, etc.), go to the Wellfleet website or call 1.833.343.5338.

A Vaden referral for outside care is unnecessary for the following conditions:

1. For an Emergency Medical Condition;
2. For medical care provided at Stanford Health Care’s Express Care Clinic or Walk in Clinic;
3. For medical care received when the Insured Student is more than 25 miles from campus;
4. For maternity care;*
5. When service is rendered at another facility during breaks, holidays, or periods when Vaden is closed;
6. For medical care obtained by a student who is not eligible to use Vaden;
7. For mental health care, including Psychiatry;
8. For the routine annual eye exam;
9. For transfers of care between specialties or coordination of care within Stanford Health Care when such care occurs as a result of an Emergency Department visit, an Express Care visit, a Walk In Clinic visit or a Vaden Health Center referral except as follows**:
   9a. Any Insured Student who is referred by Stanford Health Care’s Emergency Department, Express Care, or Walk In Clinic to Stanford Health Care’s Dermatology or Physical Therapy Department for follow up must seek evaluation and referral from Vaden Health Center. 

*No authorization or referral requirement will apply to obstetrical or gynecological care provided by In-Network Providers (including IUD services, colposcopy, and pregnancy termination).
**A written referral from Vaden is recommended for any follow-up care with a provider other than Vaden, after Emergency Services. A Vaden referral does not constitute a guarantee of benefits when Treatment is provided outside of Vaden. 

The applicable Deductible(s); Coinsurance and Copayment(s) shall apply to all of the exceptions to the referral requirement shown above.

Dependents are not eligible to use Vaden and therefore are exempt from the above limitations and referral requirements. 

Referral Penalty: Unless an exception to the Student Health Center Referral applies, if an Insured Student does not obtain a Referral from the Student Health Center then the plan will not pay for Covered Medical Expenses under this Certificate. The additional percentage or dollar amount which the Insured Student may pay as a penalty for failure to obtain a Referral is not a Covered Medical Expense and will not be applied towards the Deductible amount, if applicable, or to the Out-Of-Pocket Maximum.

Other Considerations for Referred Care

If you opted to have health insurance coverage through a local Health Maintenance Organization (HMO) such as Kaiser, that has a closed network of providers, the Vaden Health Center clinicians will not be able to refer you for specialist care since they are not part of the HMO network. The Vaden providers can still treat you at Vaden Health Center for Primary Care and Counseling and Psychological Services needs, but if you need care beyond what Vaden provides, they will be unable to refer you to a specialist at Stanford (or Menlo Medical or Sutter). You will have to access specialist care according to the terms of your HMO. (The same will most likely be true of other limited access plans.)

In addition, specimens (e.g. blood) collected at Vaden are typically sent to Quest Diagnostics, Inc. for analysis. If your health insurance plan won’t cover lab analyses to be performed by labs outside of the closed network, then you will need to have all lab work done according to the terms of your plan.

• Medical appointments at Vaden can be booked through the VadenPatient portal at vadenpatient.stanford.edu
• Mental health appointments can be booked by calling 650.723.3785
• Be sure to review the list of exclusions that apply to the referral requirement above (for example, a referral is not needed to see an Obstetrician for maternity care.)