Referrals Aren’t Required for Most Members to See Specialists

March 12, 2026

For most of our members, referrals from primary care providers aren’t required for outpatient visits with specialists. Referrals are only required for Medicare Advantage HMO members to see in-network specialists in the following markets:

• Central Florida (Tampa, Daytona, Orlando, Jacksonville)
• South Florida (Southwest Florida, Southeast Florida, Treasure Coast)
• Nevada
• Oklahoma
• Texas

Check HMO member ID cards: ID cards in these five markets indicate that referrals are required. PCPs serving these members can obtain referrals through Availity^® Essentials or by completing and submitting this form. HMO members must see in-network providers, except in emergencies.

No other HMO members require referrals to see in-network specialists.

For our Medicare Advantage PPO members, referrals are never required to see Medicare participating providers in or out of our PPO network. However, before receiving services from providers who don’t participate in our network, members may want to ask for a previsit coverage determination.

Learn more about referral requirements in our provider manual . If you have questions, contact your HealthSpring representative.