Information Regarding Patient Referrals and Frequently Asked Questions (FAQs) for Fenway Health Patients
Looking for a referral from your primary care provider (PCP) to a specialty provider outside of Fenway Health? We’re here to help!
If you receive primary care at Fenway Health and need specialty care, your PCP will refer you to a specialist or hospital that best meets your needs. While we try to keep our referrals within the Beth Israel Lahey Health System (BILH), we are able to make referrals outside of the BILH network if needed. If the specialist you see suggests that you see another specialist, please contact your PCP, who will arrange for any additional referrals.
Your Fenway Health PCP will evaluate your concerns and make a referral to a specialist when necessary. Your PCP and Referral Coordinator will work together to ensure that your relevant health information is passed along to the specialty provider.
Why is it important that I go through my PCP to get a referral?
As a part of our patient-centered model of care, it is important that your primary care team at Fenway Health be involved in any specialty care you receive. We can help determine if a referral to an outside specialist provider is needed, or if you can be treated right here in our facilities. If a referral is needed, we make sure the specialist has all the information they need before your visit. Once you have completed your visit, we will receive the specialist’s consultation notes, which will help us provide the best care for you moving forward.
Many health insurance plans require that referrals be approved prior to any scheduled appointment with a specialist. Without a referral, your health care insurer could refuse to pay the specialist’s bill. As of September 30, 2021, you may be held responsible for the cost of the office visit with the specialist.
3 Easy Steps for Getting a Referral to a Specialty Care Provider
Step 1
Talk to your PCP
Discuss the referral request with your primary care provider (PCP) at Fenway Health. You can do this calling the Medical Appointment Line at 617.927.6000 to set up an appointment. If your Fenway PCP determines a specialist is needed for your care, they will refer you, whenever possible, to a specialist within Fenway Health, or to a trusted specialist within the Beth Israel Lahey Health (BILH) network.
If you do not need our assistance with scheduling your specialty visit, your PCP will give you the name and contact information to schedule the specialty visit yourself. This can be found on your after-visit summary. It is very important that you let us know the date of your scheduled visit as soon as possible. You can let our Referral Coordinators know by logging into MyChart or by calling 617.927.6300.
If you need assistance scheduling your referral visit, please let your PCP know and our Referrals Team will be happy to assist you. Your Referral Coordinator will call the specialty office on your behalf to schedule an appointment based on your availability or they will work with you to make the phone call. If the date we schedule on your behalf does not fit within your schedule, or if you miss the appointment, you will be responsible for rescheduling the appointment.
Once your PCP helps you determine the most appropriate specialist for your needs, your Referral Coordinator will send over relevant health records describing the reason for the referral, or lab results as needed.
Step 2
Schedule your Specialty Appointment
Once you have the correct information from your PCP, please contact the specialist’s office to schedule your appointment. It is important that you attend the specialty appointment as some specialists will not reschedule your appointment if you do not keep your scheduled appointment.
Step 3
Contact the Fenway Health Referrals Team to let them know the date of your scheduled appointment
While this may seem like an extra step, it is important that your Fenway Referrals Coordinator send over the completed referral forms before your appointment date so that the specialty visit will be covered by your insurance. If you do not follow this step, your specialist may delay your appointment and/or ask you to sign a waiver acknowledging that you will pay for all charges if you’re insurance refuses to cover the visit.
You can let the Fenway Referrals Team know the date of your specialty appointment the following ways:
- Submit an online referral request form via the patient portal at fenwayhealth.org/mychart
- Call the Referrals team at 617.927.6130 and leave a message with your name, your date of birth, the name of your specialist, and the date of your appointment
- Email the Referrals Team at [email protected] and write a message with your name, the name of your specialist, and the date of your appointment
What if I need a referral and I have not discussed the reason with my primary care provider?
The best thing to do in this case would be to call our appointment line and be seen by your PCP, especially if you have not been seen by your PCP in more than six months. If you have spoken with your PCP about your health concern in the past and a referral was not made at that time, you can submit a referral request by logging into MyChart or by calling 617.927.6300.
Please note that your PCP will review your referral request and may ask that you be seen for an office visit prior to making the referral.
What if my insurance has recently changed?
Please contact our Patient Services Team or Appointment Line at 617.927.6000 as soon as possible so that we can have the most up to date insurance information. Please verify that your Fenway PCP is listed on your insurance if required. Your insurance may impact which specialists will be covered.
What if I am being referred to a provider at Fenway Health by my primary care provider outside of Fenway?
In some circumstances, Fenway Health medical providers can serve as specialists in an area of care that someone’s current primary care provider (outside of Fenway) does not provide – for example, gender affirming hormone therapy. If you are being referred by your primary care provider to be seen at Fenway:
- Discuss this referral with your current primary care provider.
- Register as a patient at Fenway Health, and schedule an appointment with your new Fenway Health medical provider. Be sure to record your:
- Appointment date and time
- Fenway provider’s name
- Fenway provider’s NPI number
These pieces of information will help your primary care provider submit the referral.
Contact the your primary care provider’s office to let them know the information you collected while scheduling. It is important that your primary care provider send over the completed referral forms before your appointment date so that the visit will be covered by your insurance. If your referral has not been received, we may delay or cancel your appointment until we have received your referral.
Referrals can be faxed to 617.425.5730. To follow up on whether a referral has been received, you may call 617.927.6130 or email [email protected].
Note: Some insurances do not allow our primary care providers to serve as a specialist, and may require transferring your primary care to a Fenway Health provider in order to receive services. Please confirm with your insurance company and Patient Services during scheduling whether a referral or transfer of your care is necessary.
Other helpful tips:
- Get in touch with our Referral Coordinator Team by emailing [email protected], accessing the patient portal, or by calling 617.927.6130.
- Referrals are processed Monday through Friday during regular office hours.
- Please allow 4–5 business days to process routine referral requests.
- Referrals are generally limited to a certain number of visits and/or may only be valid for a specific length of time. If you have follow-up visits scheduled with a specialist, please check before your appointment to confirm that your current referral will cover these visits.