UnitedHealthcare Network Coverage Update

Monday, December 3, 2018

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.

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.