At The Orthopaedic Group, P.C., we believe clear communication is essential to ensuring our patients receive the care they need without unnecessary delays. We want to share an important update that may impact patients enrolled in UnitedHealthcare Medicare Advantage plans beginning in 2026.
What’s Changing in 2026?
Starting in 2026, patients with a UnitedHealthcare Medicare Advantage plan will be required to obtain a referral from their primary care provider (PCP) before receiving specialty care. This referral requirement applies to:
- Orthopaedic care
- Spine care
- Pain management
- Rheumatology
- Other specialty medical services
This requirement applies regardless of whether care is provided by The Orthopaedic Group or another specialty practice.
The Orthopaedic Group Remains In-Network
We want to reassure our patients that The Orthopaedic Group will continue to be in-network with UnitedHealthcare Medicare Advantage plans. However, in order to be seen by one of our physicians, your primary care provider must submit a referral to UnitedHealthcare for approval.
You Have a Choice in Your Care
If your primary care provider is part of a larger healthcare system, they may automatically attempt to refer you within their own network. It’s important to remember:
- You have the right to choose your specialist
- If you prefer care at The Orthopaedic Group, you should clearly request a referral specifically to TOG
- Your primary care provider cannot legally deny your referral request
We’re Here to Help
If you experience any difficulty obtaining a referral, our team is ready to help advocate for you and guide you through the process.
📞 Business Office: (251) 476-5050
Our team will connect you with someone who can assist you.
Planning Ahead for Medicare Coverage
If you are reviewing or considering Medicare plan options in the future and prefer plans that do not require referrals for specialty care, we encourage you to:
- Review the Medicare plans accepted by The Orthopaedic Group on our website.
- Contact our office for guidance and assistance
Our Commitment to You
The team at The Orthopaedic Group, P.C. remains fully committed to your care. We will continue to advocate on your behalf and work diligently to ensure you receive the high-quality specialty care you need and deserve.
If you have questions or need assistance, please contact our business office at (251) 476-5050.
Thank you for trusting The Orthopaedic Group, P.C. with your orthopaedic care.
UnitedHealthcare Medicare Advantage Referral Requirement – FAQs
What is changing with UnitedHealthcare Medicare Advantage plans in 2026?
Beginning in 2026, patients enrolled in a UnitedHealthcare Medicare Advantage plan will be required to obtain a referral from their primary care provider (PCP) before receiving specialty care.
What types of specialty care require a referral?
Referrals will be required for specialty services including orthopaedic care, spine care, pain management, rheumatology, and other medical specialty services. This applies whether care is provided by :contentReference[oaicite:0]{index=0} or any specialty practice.
Is The Orthopaedic Group still in-network with UnitedHealthcare Medicare Advantage?
Yes. The Orthopaedic Group will remain in-network with UnitedHealthcare Medicare Advantage plans. However, a referral from your primary care provider is required to be seen by one of our physicians.
Who is responsible for submitting the referral?
Your primary care provider (PCP) must submit the referral request to UnitedHealthcare on your behalf for approval.
What if my primary care provider refers me elsewhere?
If your PCP is part of a larger healthcare system, they may attempt to refer you within that system. You have the right to choose your specialist. If you prefer care at The Orthopaedic Group, clearly request a referral specifically to TOG. Your PCP cannot legally deny your referral request.
What should I do if I’m having trouble getting a referral?
Please contact our business office at (251) 476-5050. Our team is happy to help advocate for you and guide you through the process.
Can The Orthopaedic Group submit the referral for me?
No. UnitedHealthcare requires referrals to be submitted by your pcp
