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UnitedHealthcare Community Plan
UnitedHealthcare Community Plan

UnitedHealthcare Community Plan - Healthy Michigan Plan

Frequently Asked Questions

Q.
How can I get transportation to my doctor's appointments?
A.

If you do not have a ride to get medical or dental care and services, we may provide FREE transportation or gas reimbursement for you. If there is a bus service near you, you may be asked to use it unless there is a medical reason you cannot do so. If you have any special needs, like a special lift or wheelchair van, just tell them when you call to set up your ride. It is best to call 4 days in advance for routine transportation. If you need an ugrent ride to your doctor or Urgent Care Center sooner than the Four day advance notice, call us and we will help you. To set up your ride, call 1-877-892-3995.

Q.
I heard the Healthy Michigan Plan has copays. Does your plan have copays?
A.

The Healthy Michigan Plan has co-pays.  Most co-pays will be paid through a special health care account called the MI Health Account. The monthly amount you pay will be evaluated and determined based on the services you receive in the first 6 months.

Q.
What are the co-pays?
A.

Not all services have co-pays, and not all people are required to pay copays. For example, services that help you get or stay healthy, like preventive services or certain services or medications that help you manage a chronic condition, have no co-pays. Also, some people don't have to pay co-pays, like those who are under age 21.

View more information on what services and groups have no co-pays, and the co-pay amounts. (PDF 31.63 KB)

Q.
Can I go to the emergency room without authorization?
A.

If you have an injury or sudden illness, call your PCP and follow the instructions you are given. If you have an emergency condition, go directly to the nearest emergency room.

Q.
If I go out of the state, will UnitedHealthcare Community Plan cover my medical expenses?
A.

If you have a health emergency when you are out of town or out of state, UnitedHealthcare Community Plan will cover the costs. Give the name and phone number of your PCP to the emergency room staff.

Q.
Can I see a doctor outside of the county I live in?
A.

Yes, you may see a doctor outside of your residing county if he/she is a participating provider with UnitedHealthcare Community Plan.

Q.
How can I find a Specialist?
A.

Your PCP will help you find a UnitedHealthcare Community Plan Specialist if you need one. Our Customer Service Department can also help you find a UnitedHealthcare Community Plan Specialist or you can look at our Provider Directory on this web-site. You still need to work with your PCP to set up the care.

Q.
Are there Chiropractic Services through UnitedHealthcare Community Plan?
A.

Yes.  Chiropractic care visits are covered for members age 21 and older from any participating Chiropractor for up to eighteen (18) visits every calendar year for subluxation of the spine.

Q.
Are there Podiatry Services through UnitedHealthcare Community Plan?
A.

Yes, podiatry services are covered for members age 21 and older from any participating Podiatrist.

Q.
What are my behavioral health benefits?
A.

You do not need to be sent by your PCP to see a UnitedHealthcare Community Plan behavioral health provider. You can call 1-800-903-5253 for a provider near you. You can get up to 20 outpatient visits every year.

Q.
Do I have dental coverage through UnitedHealthcare Community Plan?
A.

Diagnostic, preventive, restorative, prosthetic and medically/clinically necessary oral surgery services (including extractions) are covered. Visit www.michigan.gov for a complete list of covered services.

Q.
Do I need a referral or authorization to see my OB/GYN?
A.

No, Women may see any UnitedHealthcare Community Plan OB/GYN for well-woman or obstetrical care without being sent by their PCP.

Q.
Are all medications covered under UnitedHealthcare Community Plan?
A.

UnitedHealthcare Community Plan has a drug formulary that lists all the medications that are covered. If you need a medication that is not on the formulary, your doctor can request a Medical Exception.

Q.
What is a formulary?
A.

UnitedHealthcare Community Plan's formulary is a listing of medicines that we cover.

Q.
Is there a copay for prescriptions?
A.

Yes.  The Healthy Michigan Plan requires a $1.00 Generic and $3.00 Brand  co-pay.  When a UnitedHealthcare Community Plan doctor gives you a prescription, take it to any UnitedHealthcare Community Plan pharmacy and show them your UnitedHealthcare Community Plan ID card. You can get your diabetic supplies at a UnitedHealthcare Community Plan pharmacy too.

Q.
How can I get my prescriptions filled?
A.

When your UnitedHealthcare Community Plan doctor gives you a prescription, take it to any UnitedHealthcare Community Plan pharmacy and show them your UnitedHealthcare Community Plan ID card. You can even get many over-the-counter (OTC), medicines at no out of pocket cost when it is medically necessary and your doctor writes a prescription for you.

Q.
Does UnitedHealthcare Community Plan cover glasses and how much do you cover?
A.

You do not need to be sent by your PCP for routine eye services. Eye exams, designer type frames (Altair eyewear) and prescription lenses are covered when you see a UnitedHealthcare Community Plan -VSP vision provider. Routine eye exams, certain frames and lenses are covered every 24 months.  Replacement frames and lenses are covered once every 12 months.

Q.
Why do I need UnitedHealthcare Community Plan card?
A.

When you enroll with UnitedHealthcare Community Plan, we will send you an ID card. Take your card with you when you need medical care. With UnitedHealthcare Community Plan, you are part of an HMO. That means you choose a Primary Care Provider (PCP) who will help you get all the medical care you need.

Q.
How can I join UnitedHealthcare Community Plan?
A.

Visit www.HealthyMichiganPlan.org or call 1-855-789-5610. You can also contact your local Michigan Department of Human Services (DHS). Rrequest enrollment with UnitedHealthcare Community Plan.

Q.
Can I buy coverage with UnitedHealthcare Community Plan?
A.

No, we currently do not offer commercial policies.

Q.
How often can I change my PCP?
A.

You are able to change your PCP once a month. However we recommend that you remain with a PCP to establish continuity of care and to build a relationship.

Q.
My friend has UnitedHealthcare Community Plan and she only speaks Russian is there anyone at UnitedHealthcare Community Plan that can speak her language?
A.

Yes, we can speak to members in over 130 different languages.

Q.
How often do you contract with new doctors?
A.

UnitedHealthcare Community Plan has over 80 hospitals, over 93 Urgent Care Centers, over 2,400 PCP's and over 6,100 specialty doctors. Contracting is an ongoing process we are always looking to improve and increase our network of providers.

Q.
What does a closed panel mean?
A.

A closed panel is when a doctor's practice is full and they are not currently accepting new patients.

Q.
How do I get information on my doctor's professional qualifications and whether he/she has been the subject of any disciplinary action?
A.

UnitedHealthcare Community Plan checks the qualifications of all the doctors in our network through a state approved credentialing process. Disciplinary information is available by submitting a Freedom Of Information Act (FOIA) request to the State of Michigan. They can tell you if any action has been taken against a doctor's license.

Q.
I heard the Healthy Michigan Plan has contribution responsibilities. What is a contribution and does your plan have contributions?
A.

The Healthy Michigan Plan has contributions.  A contribution is the amount of money that you pay toward your health care coverage. Contributions are based on your income and family size and will be listed on your MI Health Account Statement. Contributions are figured based on your income and family information. Your MI Health Account Statement will tell you exactly what you have to pay.

Certain people in the Healthy Michigan Plan do not have to pay contributions at all, like pregnant women, people under 21, certain Native Americans and Alaska Natives, and people in hospice.

In addition, you can cut your contributions in HALF by completing a Health Risk Assessment and agreeing to work on or keep up with healthy behaviors.

Your MI Health Account Statement will tell you exactly what you have to pay.

Q.
What is the MI Health Account?
A.

The MI Health Account helps you keep track of your health care costs. You will receive a MI Health Account Welcome letter once you have enrolled in UnitedHealthcare Community Plan. The Welcome Letter (PDF 1,020.38 KB) will explain how the MI Health Account keeps track of health care costs, along with how co-pays and any contributions are figured.

Q.
How do co-pays work with the MI Health Account?
A.

Before you enroll with UnitedHealthcare Community Plan, you will pay any co-pays to the provider. Once you are enrolled with us and if the service is covered by us, you will pay those co-pays to the MI Health Account. You will get a statement that shows how these amounts were figured and how much to pay each month. View a sample of MI Health Account Statement.  (PDF 110.96 KB)

Q.
How is what I owe figured?
A.

The following amounts will be added together to get the total amount you owe:

  • Any contributions you owe for the next 3 months
  • Any co-pays for services shown in the statement
  • Any overdue amount from earlier statements

    The total amount will be divided by 3 to figure out your monthly payments.

     

    The MI Health Account Statement will show you what you owe and how that amount was figured. View a sample of the MI Health Account Statement. (PDF 110.96 KB)

  • Q.
    How do I pay what I owe?
    A.

    The MI Health Account Statement will tell you what you have to pay and how to pay it. You will be able to pay online and by mail.

     

    Q.
    What if I don't make my payments?
    A.

    If you don't make your payments, you may have a penalty. For example, if you have a healthy behavior reward, you could lose it. Your information may also be sent to the Michigan Department of Treasury. They can take your overdue amount from your tax refund or future lottery winnings. Your doctor cannot refuse to see you because of an overdue amount.

     

    Q.
    I have additional Questions on the MI Health Account who do I call?
    A.

    Please call the Beneficiary Help Line at 1-800-642-3195 (TTY: 1-866-501-5656) for more information about the MI Health Account.

    Q.
    What is the Healthy Michigan Health Risk Assessment?
    A.

    After you have enrolled with UnitedHealthcare Community Plan, complete the Healthy Michigan Plan Health Risk Assessment form below. The questions in Section 1 may look familiar if you called MI Enrolls to choose your health plan during enrollment. It is okay to complete them again, even if your answers don't match each time you answer. There are no wrong answers. It is important to see your doctor for a check-up as soon as possible after you enroll with us. Before your appointment, complete the Healthy Michigan Plan Health Risk Assessment form. Take this form with you when you go. Your doctor and UnitedHealthcare Community Plan will use this information to better meet your health needs.

    You can also earn rewards when you agree to address or maintain healthy behaviors. 

    Questions?

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    TTY: 711

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