Follow Guidelines for Making Physician Referrals for HMO Members 

July 29, 2025

When members with Blue Advantage HMOSM, Blue Advantage PlusSM HMO, Blue EssentialsSM and My Blue HealthSM plans request a referral for medically necessary services, follow these steps:

  • Call the customer service number on the member ID card to request a referral. 
  • Provide the initial request ID and include a detailed explanation for additional review.

How long does it take? We will complete referral requests within five business days and urgent requests within 24 hours or less.

When out of network services are requested: We will provide at least two in-network options, if available.

  • If the requesting provider denies in-network options, we will review the request.
  • If the provider accepts an in-network option, we will update the request to the in-network recommendation and approve it.
  • If there is only one or no in-network option, we will approve the out-of-network provider and notify the primary care provider of the approval.

We follow Texas Department of Insurance referral guidelines 11.1611 Section c (3).