If You Accept Medicare, You Can See Our PPO Members
April 9, 2026
If you’re a Medicare provider, you may treat members of our Medicare Advantage PPO plans without a referral, even if you don’t participate in our networks.
The only requirements are that you agree to see the member as a patient, accept Medicare and submit their claims to HealthSpring. You’ll collect a copayment or coinsurance at the time of service, depending on the member’s plan.
Check member ID cards: To identify these members, look for “PPO” listed as the plan type at the top of their member ID card.
Individual sample ID card
Employer group sample ID card
Employer group members: You can identify these members by the employer’s name listed at the top of their member ID card. Members with coverage through employer groups pay the same out of pocket for in-network and out-of-network covered services.
Previsit coverage decisions: Referrals aren’t required for in-network or out-of-network providers. However, members may want to request a previsit coverage determination to confirm the services they’re getting are covered and medically necessary. Without a previsit coverage decision, members will be responsible for the full cost of the services if it’s determined they’re not covered or medically necessary.
Prior authorization: Prior authorization may be required for certain services or medications. Learn about prior authorization requirements.
Submit claims to HealthSpring: Refer to submitting claims for more information.
If you have questions, call the number on the member’s ID card or Provider Customer Service at 800-230-6138 Monday–Friday, 7 a.m.–8 p.m. CT.
Out-of-network/noncontracted providers are under no obligation to treat HealthSpring True Choice (PPO) members, except in emergency situations.
Verification of eligibility and benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility, any claims received during the interim period and the terms of the member’s evidence of coverage applicable on the date services were rendered.