More Medicare Advantage Plans Requiring Referrals

United Healthcare recently released an update notifying providers that more of their Medicare Advantage plans

such as AARP Medicare Complete will begin require referrals from a primary care physician prior to seeing network specialists. This change will go into effect in January 2015. UHC had indicated that all plans with this requirement will have a PCP clearly listed on the front of the insurance card, and a “referral required logo” on the back of the card.

As patients can select from both HMO and PPO versions of the Medicare Complete plan, be sure to inspect every patient insurance card for the referral requirement prior to service. Per UHC, the referral requirement will also be indicated on when verifying patient eligibility and benefits. Providers can also view and manage referrals from this portal.

Other Medicare Advantage insurances such as Cigna Healthspring also have plans that require referrals from PCPs prior to visiting network specialists. Make sure to check the cards of all your Medicare Advantage patients to ensure your services will be covered. To review the UHC update, please visit the link below.

UHC Medicare Advantage Update

Brandon McCurdy