Specialty Care Coordination and Referrals

Effective June 1st, UCSF Health will become the designated provider of primary care services for UCSF learners enrolled in the UC Student Health Insurance Plan (UC SHIP). If you believe you need to see a specialist, your first step is to make an appointment with a primary care provider.

UCSF Health primary care providers possess a broad range of knowledge and skills and will work with you to provide continuity of care for any health issue you may encounter. For any condition, your provider will assess if a referral to a specialist or diagnostic testing is needed and guide you in obtaining that care.

Services received outside UCSF Health Primary Care require a referral in order for the UC SHIP to pay the claim. This applies to specialty-care follow-up visits as well. Out-of-pocket costs are the lowest if you select a UC Family provider or Anthem Blue Cross in-network provider. Referrals expire after 12 months and are limited to the number of visits indicated by your provider when writing the referral.

When you are instructed to follow up with a specialist after an ER or Urgent Care visit, you must schedule an appointment to discuss and obtain the required referral from a primary care clinician.

When you are referred to a healthcare provider outside of UCSF Health Primary Care, follow the steps below:

Step 1: Provide your Anthem ID Card to the Specialty Office

Member ID cards for Anthem Blue Cross are available to you via the Sydney Health mobile app.

Step 2: Get Follow-up Appointments Authorized

If your specialist requests follow-up visits or a referral to another specialist, make sure to ask the specialist’s office to make the request to your UCSF Health Primary Care Provider for authorization. Your specialist should also fax over any applicable clinical notes from your visit. Requests not authorized by UCSF Health Primary Care will not be covered.

Step 3: Out-of-network Providers

If the specialist is out-of-network providers and does not bill the insurance company directly, then you will need to pay up-front for the services and get reimbursed by the insurance company by completing the Medical Claim Reimbursement Form. In this case, make a copy of your receipt and itemized bill, complete a claim form, and mail both to Anthem at P.O. Box 60007, Los Angeles, CA 90060-0007. If billing issues arise, please review the Medical Billing Process.

All specialty care requires a co-payment per visit, and some visits require that you meet your annual deductible and pay a co-insurance fee. See Medical Billing Process for more information.