How Do I Get a Referral?

Referral Request Process

If a care provider determines that you need medical services that are not available at MIT Medical, the provider may refer you to an outside clinician and submit a referral request to the Health Plans office for review. If approved, most referrals are valid for one year or until your insurance expires, whichever comes first. Occupational therapy, physical therapy, and speech therapy services must be completed within 60 days of the first date of service. If these services continue into a new calendar year, you must request an updated referral.

Your Coverage

A care provider’s suggestion that outside services are needed is not a guarantee of health plan coverage. If your care provider suggests outside services, ask if he or she is submitting an official referral request on your behalf.

Students and Affiliates with the Extended Insurance Plan (SEIP or AEIP)

To determine what outside services are covered by your benefit plan, see the Student Health Plan Overview or Summary Plan Description, or call Claims and Member Services at 617-253-5979.
All referrals will be made to a Blue Cross Blue Shield (BCBS) PPO provider.

For more information on the referral process, review the Frequently Asked Questions for Students and Affiliates with the Extended Insurance Plan.

Members of the Traditional and Flexible MIT Health Plans

To determine what outside services are covered by your benefit plan, see the MIT Traditional Health Plan brochure or summary plan description, the MIT Flexible Health Plan brochure or summary plan description, or call Claims and Member Services at 617-253-5979.
Traditional Health Plan members will be referred to an HMO Blue of MA provider.
Flexible Health Plan members will be referred to a Blue Choice of MA participating provider.
For information about using mental health benefits and services, see the Blue Cross Blue Shield of Massachusetts (BCBSMA) Managed Care Behavioral Health Network frequently asked questions (FAQ).
All members of the Traditional MIT Health plan, and those members of the Flexible MIT Health Plan seeking to use their in-network benefit, must receive Health Plan approval for any outside visits before being seen by an outside clinician. Make sure you have received Health Plan approval before going to the appointment or receiving any services from an outside clinician.
Members of the Flexible MIT Health Plan who want to use the flexible option of their plans do not need to obtain referrals for covered services. Deductibles and coinsurance will apply.

For more information on the referral process, review the Frequently Asked Questions for members of the Traditional and Flexible MIT Health Plans.

Your Responsibilities

If you schedule an outside appointment yourself, you must inform your MIT Medical care provider’s office with the scheduled date of the appointment and the outside provider’s name, address, and phone number. (This step is not necessary for Flexible Health Plan members who are accessing their out-of-network benefits.)
You must inform your MIT Medical care provider’s office of the scheduled date of your first session of occupational therapy, physical therapy, or speech therapy services.
Ask the outside provider to provide periodic updates on your health status to your MIT Medical care provider.
If the provider to whom you were referred orders additional tests or refers you to another provider or facility, you must inform your MIT care provider, who must request approval for the additional services.

Get a referral?