Recommend a Provider for the HealthSelect Network

If your doctor or other provider is not currently in the HealthSelectSM network, you can recommend that they be added by filling out this form.

Please keep in mind:

  • Your recommendation does not guarantee that the provider will be accepted into the network.
  • It may take up to 90 days for the provider to be accepted into the network.
  • Providers must meet all established credentialing requirements.
  • Providers must agree to all contract provisions, policies and procedures.

An asterisk (*) indicates a required field.

Specialty type (select):