Referrals, Empire Plan supplement - 2022 UnitedHealthcare Administrative Guide

The Empire Plan does not include requirements for a PCP to coordinate referrals for specialist care. Members may self-refer to any health care provider for covered services and receive appropriate in-network or out-of-network benefits based on the network status of the health care provider.

Anesthesia services

You will help ensure all covered anesthesia services rendered at your practice location are performed by participating health care providers for as long as the Agreement is in effect.

Laboratory services

We only reimburse for laboratory services you are certified to perform through the Federal Clinical Laboratory Improvement Amendments (CLIA). You must not bill our members for any laboratory services if you don’t have the applicable CLIA certification.

Other services

If you determine a member requires treatment or services from another health care provider, you must use reasonable efforts to refer them to a network provider.