UnitedHealthcare Network Coverage Update

<p>Some members under the UnitedHealthcare (UHC) Group Medicare Advantage plans have received letters from hospitals stating they may no longer be in-network with UHC. While it is true that UHC may be out-of-network for these hospitals, State Health Plan members are still able to receive services from them and their employed physicians at no additional cost.<br /> &nbsp;</p>

Some members under the UnitedHealthcare (UHC) Group Medicare Advantage plans have received letters from hospitals stating they may no longer be in-network with UHC. While it is true that UHC may be out-of-network for these hospitals, State Health Plan members are still able to receive services from them and their employed physicians at no additional cost. Woman working out at gym

Here’s why: Both the UHC Base and UHC Enhanced plans are considered National Preferred Provider Organization plans with a “passive” provider network, which allows members the flexibility to use providers in or out of UHC’s large national network. An out-of-network provider must participate with Medicare and accept the UHC plans.

In-network providers must accept the plan as part of their contract and continue to see the member if the member is a current patient. They will be paid according to their contract with UHC.  If the provider is out-of-network, they will be paid based on Original Medicare’s fee/payment schedule. Plus, if the out-of-network provider does not accept the Medicare fee schedule amount, they may bill an excess charge BUT it will be paid by UHC, NOT the member.

If you are a UHC member and need help finding a provider, call 866-747-1014, TTY 711, 8 a.m. – 8 p.m. local time, 7 days a week.
 

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