Selecting a Provider for UnitedHealthcare Enrollments

CB0005-15

March 2, 2015

Reminder: Each enrollment application must include a Primary Care Physician (PCP). Correctly spell the PCP’s name and make sure their provider number is written legibly and accurately.

Noted below are best practices agents should use when looking up, selecting and communicating information about providers:

  • Use the most accurate provider look-up source
  • It is not recommended to use a physician’s office as a source of truth or any web searches not associated with a UnitedHealthcare tool (exception: Vision)
  • Printed provider directories are a higher risk for outdated/inaccurate information
  • Ask consumers what types of doctors and facilities are important to them, including specialists they only see occasionally
    • Look up all physicians (PCP and specialist)
    • Confirm that the provider or facility is in-network for the plan in which the consumer is enrolling. A physician can be in the network for one plan, multiple plans, or all plans in a market
  • Set expectations to avoid surprises
    • If the network is narrow or the plan requires referrals to see a specialist, make sure that is communicated to the consumer.
    • Help the consumer understand the value of the PCP and work with them mto find one in the UHC network, if they don’t currently have one. Otherwise a PCP auto-assignment will occur, and sometimes will cause a member complaint.
  • Although it’s not common, ensure the consumer understands that networks/contracts can change throughout the year. If a provider contract is terminated, consumers can contact customer service to change providers.
    • Consumers must understand networks/contracts can change throughout the year. In the event their provider(s) is/are no longer contracted with UnitedHealthcare, they can contact customer service or their agent to select a new provider. Consumers must understand they are enrolling for a full year.
    • If a consumer is concerned or has doubts about the network status of a provider they can call customer service, their agent, or lookup the physician on myuhc.com to confirm network status.

As always, we thank you for your support and cooperation. For questions or comments, please email us at Compliance@YourMedicare.com or you may call the toll-free number listed below.

FOR AGENT USE ONLY. NOT FOR USE WITH CONSUMERS.

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