If you have a Humana or UnitedHealthcare Medicare Advantage plan, your insurance benefits for 2026 may include new or stricter referral requirements for specialty care.
These rules are set by your insurance plan — not by our office — and they matter.
Established Patient? That Does Not Exempt You
If your Medicare Advantage plan is new for 2026, referral requirements may apply even if you have been an established patient in our office for years.
A new plan resets the rules.
Referral Requirements Vary by Plan
Not all Humana or UnitedHealthcare Medicare Advantage plans require referrals. Requirements depend on:
- Your specific plan type (HMO, HMO-POS, PPO, etc.)
- Your individual benefit design
- The reason for your visit
Because of this variability, patients must verify their own coverage directly with their insurance company.
What Our Office Does — and Does Not — Do
Our office:
- Does not verify whether your plan requires a referral
- Does not verify referral accuracy
- Does not override insurance referral rules
If your plan requires a referral and it is missing or does not match the specific reason for your visit, your insurance company may deny the claim.
What Happens If a Claim Is Denied
When a claim is denied due to referral requirements, the charges become the patient’s responsibility. Unfortunately, this is not something that can be corrected retroactively.
How to Avoid Problems
Before your appointment:
- Contact your insurance company
- Ask if your Medicare Advantage plan requires a PCP referral
- Confirm that the referral (if required) must match the reason for your visit
A short phone call ahead of time can prevent delays, denials, and unexpected bills.
Bottom Line
If you have a Medicare Advantage plan for 2026, do not assume last year’s rules still apply.
Know your plan. Know your requirements. Insurance rules are the patient’s responsibility.
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