How to Determine if a Referral is Needed

Starting January 2026, United Healthcare is increasingly requiring referrals for many of their covered patients to see a specialist, such as an orthopaedic surgeon. To know for certain, you should take the following steps:

• Check Your ID Card: Look for language like "Referrals Required" printed on your member identification card.
• Review Your Plan Documents: Sign in to your member account on the UnitedHealthcare website or the UHSS portal to access your specific coverage documents and details on referral and prior authorization requirements.
• Call Member Services: If you are unsure after checking online resources, call the toll-free number on the back of your member ID card to speak with a representative who can confirm your benefits.

General UnitedHealthcare Referral Information

• HMO Plans: Generally require a referral from your Primary Care Provider (PCP) for most specialist visits.
• PPO/Choice Plus Plans: Typically offer the freedom to see network specialists without a PCP referral, though you save money by staying in-network.
• Exempt Services: Certain services often do not require a referral, regardless of plan type, including emergency care, most mental health services, OB/GYN visits, and some lab/radiology services.
• Prior Authorization: A referral is different from prior authorization. Some services may require a separate prior authorization even if a referral is not needed, which also must be obtained before receiving care.
• Primary Care Physicians: Primary Care Physicians can use the Online Tools available on the UHC provider portal or the UHSS/UMR portal to verify if a referral or prior authorization is needed for a specific service or specialist before your appointment.

Patients must contact their primary care physician to request the referral. KOC cannot obtain the referral on a patient’s behalf.