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UnitedHealthcare Community Plan
UnitedHealthcare Community Plan

UnitedHealthcare Community Plan

Frequently Asked Questions

Click on a question to reveal the answer.

Q.
What is Medicaid?
A.

Medicaid is a health insurance program for people with low income who meet certain eligibility requirements. Programs can vary from state-to-state. Medicare is a federal health insurance program for people who are age 65 or older, disabled persons, or those with end-stage kidney disease. Medicare eligibility is not based on income, and basic coverage is the same in each state.

Q.
What documents will I need when I apply for Medicaid?
A.

When you apply for Medicaid, you must fill out an application form. You will also need to have various documents:

  • Information about household members (name, date of birth and Social Security number)
  • Rent or mortgage information
  • Expenses (utilities, daycare, etc.)
  • Vehicle information
  • Bank statements
  • Income (pay stubs)
  • Proof of disability or medical records showing a lasting medical condition
  • Recent medical bills
  • Proof of citizenship
  • Additional information as requested
Q.
What is an MCO (Managed Care Organization)?
A.

Managed Care Organizations (MCOs), like UnitedHealthcare Community Plan, provide health care services to members through doctors, hospitals and other health care providers through contract agreement. The MCO also provides non-medical services based on the benefit package.

Q.
Do I get to choose my MCO?
A.

Yes, you can choose your MCO upon initial enrollment in a health plan or during the open enrollment period. You will default to an MCO if you do not choose one.

Q.
Will I get a different Medicaid card?
A.

No, but you will have the MCO card in addition to your Medicaid card. After you choose UnitedHealthcare Community Plan as your MCO, we will send you your new member ID card in the mail.

Q.
My primary care physician (PCP) does not accept UnitedHealthcare Community Plan, what must I do?
A.

You need to choose a new primary care provider (PCP).  You can search our online provider directory or call us at 1-877-877-8159 to select a new PCP. PCP’s may be changed up to three times a year.

We encourage you to call and make an appointment with your new doctor as soon as possible.

Important: Please contact your old PCP to request copies of your medical records.

 

 

 

 

 

 

Q.
Can I continue to see my doctor after January 1, 2015?
A.

Yes. However, if your doctor is not participating in UnitedHealthcare Plan, you will have up to 90 days to choose a new doctor. 

Q.
Will it cost me anything to change to a new doctor or hospital?
A.

No, there are no changes to your benefits or payments. 

Q.
What is the Continuity of Care Provision, and why is it only 90 days?
A.

If you are getting medically necessary medical care, the Continuity of Care Provision will allow time for you to adjust to your new health plan providers and services. The 90-day period is sufficient to allow for your treatment to be completed or to make arrangements for care to continue with a provider that is on our list.

Exceptions can be made if the care plan takes longer than 90 days (i.e., pregnancies).

Q.
Who is responsible for helping me obtain Continuity of Care?
A.

Your doctor, who is managing your care, should contact UnitedHealthcare Community Plan to inform us of any existing prior authorization.  

Q.
I am pregnant, and my OB/GYN does not accept UnitedHealthcare Community Plan. Where do I go for my pre-natal care and delivery?
A.

Services will be allowed to continue with your current OB/GYN provider until you deliver. When you go to the doctor, make sure your doctor contacts UnitedHealthcare Community Plan to inform us of any existing prior authorization at 1-800-366-7304 or by fax 1-877-877-8230. 

Q.
What about prescriptions?
A.

Prescription medication is covered by UnitedHealthcare Community Plan and you have to present your member ID card for this benefit. If you have questions, please call the Pharmacy Benefits line at 1-800-842-4195 (TTY 711).

Q.
What about dental coverage?
A.

Age 20 and younger: Covered by Delaware Medicaid. Please call 1-800-372-2022 for more information.

Age 21 and older: Covered by UnitedHealthcare. One cleaning (prophylaxis) and one periodic evaluation per year, one full mouth series x-ray per three years.

Removal of bony impacted wisdom teeth is considered a medical necessity and is covered by UnitedHealthcare Community Plan. 

Is dental care covered?

Age 20 and younger: Covered by Delaware Medicaid. Please call 1-800-372-2022 for more information.

Age 21 and older: Covered by UnitedHealthcare. One cleaning (prophylaxis) and one periodic evaluation per year, one full mouth series x-ray per three years.

Removal of bony impacted wisdom teeth is considered a medical necessity and is covered by UnitedHealthcare Community Plan. 

Q.
What do I need to tell the doctor’s office when I go for my office visit?
A.

Tell them you have a new insurance card. Give them your state-issued Medicaid card and your new UnitedHealthcare Community Plan member ID Card.

Q.
Who do I call about problems or questions?
A.

Enrollment and General Questions: Call the Health Benefit Manager at 1-800-996-9969

Billing problems and questions: Call UnitedHealthcare Community Plan at 1-877-877-8159.

Q.
Who do I call about appeals?
A.

If a service is denied and you disagree, you may call us about an appeal at 1-877-877-8159. Your member handbook tells you all about appeals and hearings.

Questions?

Ready to get started?

Call Us:
1-877-877-8159
TTY: 711

Monday through Friday, from 8 a.m. to 7 p.m.

Lookup Tools

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Member Information

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