On May 28, 2026, the American Society of Interventional Pain Physicians (ASIPP) Board of Directors submitted a formal letter to UnitedHealthcare leadership regarding recently implemented referral requirements affecting Medicare Advantage HMO and HMO-POS plans.
The letter, addressed to UnitedHealthcare Chief Executive Officer Stephen J. Hemsley and Chief Medical Officer Anne Docimo, MD, expresses significant concerns regarding revisions to the referral process that took effect on April 30, 2026.
The letter states that the updated requirements have created substantial administrative burdens for referring physicians and may result in delays, reduced referrals, interruptions in continuity of care, and barriers to medically necessary interventional pain management treatment for Medicare Advantage beneficiaries.
ASIPP requested that UnitedHealthcare reconsider the revised policy and either return to the previous one-time referral process or implement a simplified annual renewal process comparable to prior referral standards.
The letter notes that the current revised process requires referring physicians to enter separate referrals for each individual practitioner within an interventional pain management group practice, rather than allowing a single referral for the practice itself. ASIPP stated that this approach creates unnecessary administrative burdens and may delay timely patient access to care.
The Board of Directors further emphasized that Medicare Advantage plans are required to follow established Medicare coverage policies, including applicable Local Coverage Determinations (LCDs) and national Medicare coverage standards.
Referenced Medicare Local Coverage Determinations include:
- LCD – Facet Joint Interventions for Pain Management (L38773):
https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=38773&ver=30&ContrId=228&ContrVer=2&CntrctrSelected=228*2&Cntrctr=228&name=&DocType=2%7C4&bc=AAAAgACAAAAA&= - LCD – Epidural Steroid Injections for Pain Management (L39015):
https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39015&ver=16&bc=0 - LCD – Sacroiliac Joint Injections and Procedures (L39383):
https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39383&ver=13&bc=0
The letter also references federal Medicare Advantage coverage requirements under 42 U.S.C. § 1395w-22(a)(1)(A), CMS Medicare Managed Care Manual Chapter 4, Section 10.1, and 42 C.F.R. § 422.101(b).
Read the full letter:
https://asipp.org/sent-letter-to-steven-hemsley-and-anne-domico-requirements-for-medicare-advantage-hmo-hmo-pos-plans-5-26-26/
Thank you for consistently showing up with heart full of compassion
I sent a letter to UHC CEO on 5/11/26 complaining about the need for PCP referrals for HMO plans but not Supplement plans and was told today that Tim Noel and UHC cannot change the requirement of the plans set forth by Medicare .
The change, which is likely to have the effect of reducing specialist visits and thus saving United Healthcare millions if not billions of dollars, isn’t taking place in a vacuum. Rather, it’s one more assault on seamless and efficient health care coverage. Patient inconvenience seems to be a cornerstone of this icon of Big Insurance’s plan for dealing with what its executives claimed last year were $6.5 billion in annual higher costs.