Columbia University Health Services

To utilize the benefits available under the Columbia Student Medical Insurance Plan for off-campus services, except in emergencies, a referral from an on-campus Primary Care Medical Services (PCMS) or Counseling and Psychological Services (CPS) clinician is required.

• You must obtain the referral from a Health Services at Columbia provider prior to receiving any off-campus medical services, counseling, or psychiatric services. Services rendered without an appropriate referral will not be covered under the Student Medical Insurance Plan.
• PCMS providers write referrals after evaluation and treatment on-campus has been completed and as the need for outside services is clinically indicated.
• You do not need separate referrals each time you see the same provider for an on-going condition.
• If you are injured or become ill while traveling or spending an extended time away from Columbia, you will need to call and speak with your PCMS provider, who will help you determine what kind of treatment is appropriate.
• When you are not in New York City during semester breaks, holidays, or the summer, you will be covered for primary care, as well as other services, from the Aetna network of providers, as long as you get a referral from your on-campus provider in advance.
• Even with a referral, when seeing an off-campus consulting provider you will be responsible for a co-pay (preferred providers – members of the Aetna network) or a deductible (non-preferred providers). If you are seeing a non-preferred provider (not a member of the Aetna network), you may also be responsible for the Covered Person’s co-insurance charge.
• Example: For a visit with a non-preferred dermatologist, the Aetna Reasonable Rate is $200. Under the Plan, 70 percent of that rate is paid by Aetna; the provider may charge the patient the remaining co-insurance amount of 30 percent. The total charge to the patient for the visit would be:

          Deductible                 $25

          30% co-insurance       $60

          Total Payable             $85

• It is important to ask about the charges that will be payable at the time you make the appointment for the visit.
• Advance consultation with a Health Services clinician is not required in a medical emergency.

A referral is not required under the following conditions, though your PCMS provider can assist you in finding appropriate services.

• For emergencies, you must return to PCMS for necessary follow-up care
• pre-natal and obstetrical care
• elective termination of pregnancy
• for women age 35- 40, one baseline mammogram; one per year thereafter for women age 40 and older. Coverage will be provided more frequently if recommended by a Physician for a Covered Person who has a prior history of breast cancer or who has a first degree relative with a prior history of breast cancer
• continuing treatment for a condition established in a prior year under the Columbia Student Medical Insurance Plan
• one annual routine Pap smear screening and office visit; Pap smear screenings are available on campus, where a student pays no copay or deductible. One annual routine Pap smear screening and office visit will also be covered off-campus without a referral. If additional appropriate testing is performed as part of an off-campus annual Pap smear screening office visit, benefits for the testing will be payable in accordance with the Policy and no referral will be needed.

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