All participating providers are carefully selected according to objective requirements and standards. The criteria for doctors include professional credentials, education, medical training and experience and hospital admitting privileges. Whenever possible, doctors are either board certified or board-eligible in their areas. For hospitals, the criteria include accessibility, quality of care, community reputation, available services and cost efficiency. Network managers regularly re-evaluate participating providers to make sure they continue to meet requirements.
Network participation status changes from time to time, so it is important to verify that your doctor or hospital participates with the UnitedHealthcare network before scheduling an appointment or procedure Participating provider information is available via the UnitedHealthcare web site (www.myuhc.com) and/or by calling 800 387 7508 toll free.
If you receive a covered service from an out-of-network provider and were informed incorrectly prior to receipt that the provider was an in-network provider, either through a database, provider directory, or in a response to your request for such information (via telephone, electronic, web-based or internet-based means), you may be eligible for in-network benefits.
It is possible that you might not be able to obtain services from a particular in-network provider. The network of providers is subject to change. Or you might find that a particular in-network provider may not be accepting new patients. If a provider leaves the network or is otherwise not available to you, you must choose another in-network provider to get in-network benefits. However, if you are currently receiving treatment for covered services from a provider whose network status changes from in-network to out-of-network during such treatment due to expiration or nonrenewal of the provider's contract, you may be eligible to request continued care from your current provider at the in-network benefit level for specified conditions and timeframes. This provision does not apply to provider contract terminations for failure to meet applicable quality standards or for fraud. If you would like help to find out if you are eligible for continuity of care benefits, please call the telephone number on your ID card
If you are currently undergoing a course of treatment utilizing an out-of-network physician or health care facility, you may be eligible to receive transition of care benefits. This transition period is available for specific medical services and for limited periods of time. If you have questions regarding this transition of care reimbursement policy or would like help determining whether you are eligible for transition of care benefits, please contact UHC at the telephone number on your ID card.
Do not assume that an in-network provider's agreement includes all covered services. Some in-network providers contract with UHC to provide only certain covered services, but not others. Some in-network providers choose to be an in-network provider for only some of UHC's products. Refer to your provider directory or contact UHC for assistance.
UnitedHealthcare's credentialing process confirms public information about the provider's licenses and other credentials, but does not assure the quality of the services provided.
If UnitedHealthcare determines that you are using health care services in a harmful or abusive manner, you may be required to select a network physician to provide and coordinate all of your future covered health services.
If you don't make a selection within 31 days of the date you are notified, UnitedHealthcare will select a single network physician for you.
In the event that you do not use the selected network physician, benefits will not be paid.