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Important Notice:

Network availability may vary by state, and a specific health care provider's contract status can change at any time. In addition, only the office locations listed are in your network. Visiting a physician at any other location may result in reduced benefits. Therefore, before you receive care, it is recommended that you verify with the health care provider that he or she is still contracted with your network and at the location where you are planning to visit the physician.

Please be aware, providers are not required to accept repriced amounts for denied charges (unless their contract states otherwise). Previously LabCorp routinely accepted the repriced amounts on denied charges. but has since changed their policy and are no longer accepting repriced amounts for denied charges as of 10/01/18.

State Disclaimers

 

California:

California Medical Necessity Review Process for Mental Health: Licensed nurses perform the initial clinical review for pre-service, concurrent and/or post service/retrospective requests consistently using clinical review criteria to determine medical necessity of the mental healthcare services. All requests that cannot be certified through an initial review are sent to a clinical peer for determination. The reviewer will request only information reasonably necessary to make a determination.

 

In the case of a review of pre-service or concurrent care, the decision not to approve the service based on medical necessity will be made within 5 business days of receipt of information reasonably necessary to perform the review. A decision regarding services that have been completed will be made within 30 days of receipt of information reasonably necessary to perform the review. Expedited reviews will be performed when the insured’s condition is such that they face an imminent and serious threat to his or her health or could jeopardize the insured’s ability to regain maximum function. An expedited review determination will be completed within 72 hours of receipt of information reasonably necessary to perform the review. The decision will be communicated verbally, by fax or email within 24 hours to the provider and in writing within 2 business days to the insured. Notifications will provide an explanation of the reasons for the decision, a name and number to contact for questions and instructions on how to file an appeal.

In the case of a concurrent review, care shall not be discontinued until the treating provider has been notified of the insurer’s decision and a care plan has been agreed upon with the treating provider that is appropriate for the medical needs of the patient.

The information provided to you is a guideline used by this insurer to authorize, modify, or deny health care benefits for persons with similar illnesses or conditions. Specific care and treatment may vary depending on individual need and the benefits covered under your insurance plan.

Click Here for the Golden Rule Insurance Company California Grievance Procedures.

Colorado:

UnitedHealthcare Choice Plus has providers in every Colorado county except Gilpin and San Juan.

UnitedHealthcare Options PPO has providers in every Colorado county except Gilpin and San Juan.

Connecticut:

UnitedHealthOne performs an annual survey in the state of Connecticut. Click here for results.

Delaware:

You may request a printed copy of a network provider directory by:

1. Contacting us at the toll-free number on the back of your ID card.
2. Sending us a secure message using the myuhone.com member portal. If you are not already registered, select the Register Now button to get started. You will need your ID number found on your ID card or policy documents to validate your account. Once registered, you can sign in at any time and select the Send a Secure Message link to submit your request.
3. Faxing your request in writing to (801) 478-7561.
4. Mailing your request in writing to Claims Department, P.O. Box 31374, Salt Lake City, UT 84131-0374.

Every Delaware provider that you use must clearly disclose to you in writing if they (or any provider practicing in their group practice or facility) are not in your network (non-network). Each non-network provider in Delaware must obtain your written consent prior to treating you, and require you to sign a network disclosure statement indicating you will accept financial responsibility for any non-network services which may not be covered by your plan. You cannot be balanced billed by a non-network provider if the non-network provider (or the facility based provider employing non-network facility based providers) fails to provide you with the required network disclosure statement and obtain your written consent. This requirement includes the disclosure of non-network lab services ordered by your provider or facility.

Florida:

For Florida Residents, Legislation Effective 7/1/2004: Direction on appropriate utilization of emergency services and alternative urgent care services. Choosing the Right Health Care Setting:

Emergency Rooms: When you or a loved one is hurt, you want the best care. Deciding where to go isn't always easy. You may be tempted to go to the emergency room (ER). But, this may not be the best choice. At the ER, true emergencies are treated first. Other cases must wait--sometimes for hours. And, it may cost you more. Go to the ER for heavy bleeding, large open wounds, sudden change in vision, chest pain, sudden weakness or trouble talking, major burns, spinal injuries, severe head injury or difficulty breathing. Of course, each case is unique. If a situation seems life-threatening, take action. Call 911 or your local emergency number right away.

Urgent Care: Sometimes, you may need care fast. But, a trip to the ER may be unnecessary. You may want to try an urgent care center. They can treat many minor ailments. Chances are, you won't have to wait as long as at the ER. You may pay less, too. An urgent care center can help with: sprains, strains, minor broken bones, mild asthma attacks, minor infections, small cuts, sore throats or rashes.

Clinical Care: If it's not urgent, it's usually best to go to your own doctor's office. Your doctor knows you and your health history. He or she can access your medical records. And, he or she can provide follow-up care or refer you to specialists.

Louisiana:

The Louisiana Hospital-Based Physician Disclosure List is for informational purposes only and contains the names and location of certain hospital-based physicians located in the State of Louisiana as reported to UnitedHealthcare. It is provided in accordance with the Louisiana Consumer Health Care Provider Network Disclosure Act. It is not part of UnitedHealthcare's directory of Network Providers and the physicians on this list may not be contracted with UnitedHealthcare and includes Network and Non-Network Providers.

Health care services may be provided to you at a network health care facility by facility-based physicians who are not in your health plan. You may be responsible for payment of all or part of the fees for those out-of-network services, in addition to applicable amounts due for copayments, coinsurance, deductibles, and non-covered services. Specific information about in-network and out-of-network facility-based physicians can be found by clicking on the link above or by calling the customer service telephone number on the back of your ID card.

Maryland:

Maryland Gap Referral and Appeal Review Process

New Jersey:

Disclosures to Covered Persons Regarding Out-of-Network Treatment

Out-of-Network Costs for Members in New Jersey Insurance Plans

North Dakota:

Click here for North Dakota Grievance Procedures.

Texas:

A facility-based physician or health care practitioner may not be a member of your health benefit plan's provider network, even though the physician or health care practitioner provides health care services at an in-network health care facility. If the physician or health care practitioner is not a member of your health benefit plan's provider network, you may be responsible for payment of the physician’s or practitioner’s fees not paid by your health benefit plan.

Click here for a list of UnitedHealthcare in-network health care facilities that may staff facility-based physicians or health care practitioners which may not participate in your health benefit plan's provider network.

Click here for additional Information for Texas Insureds.  

Wisconsin:

You are strongly encouraged to contact us to verify the status of the providers involved in your care including, for example, the anesthesiologist, radiologist, pathologist, facility, clinic or laboratory, when scheduling appointments or elective procedures to determine whether each provider is a participating or nonparticipating provider. Such information may assist in your selection of provider(s) and will likely affect the level of co-payment, deductible and amount of co-insurance applicable to care you receive. The information contained in this directory may change during your plan year. Please call the Customer Service phone number on your ID card to learn more about the participating providers in your network and the implications, including financial, if you decide to receive your care from nonparticipating providers.

• www.myoptumhealthcomplexmedical.com/gateway/public/transplants/transplants.jsp

Once on the OptumHealth page, click on either the "Commercial Transplant Centers of Excellence Network" link or the "Commercial Pediatric Transplant Centers of Excellence Network" link (as applicable).