Through UnitedHealthcare you and all covered members of your family will receive many healthcare benefits. To get more information about your covered benefits, please read your accompanying RIte Care or Rhody Health Partners Benefit Summary or call Member Services at 1-800-587-5187 or Hard of Hearing 711.
Which services require prior authorization?
Some services require prior authorization. It is the responsibility of your doctor to get prior authorization when required.
Where do I get prescriptions filled?
The RIte Care and Rhody Health Partners Directory of Physicians and other Health Care Providers lists pharmacies where you can get your prescriptions. Just bring your prescription and show your identification card at a participating pharmacy to get your prescription filled. Your Physician and Health Care Provider Directory is part of your member materials packet. Many pharmacies stay open 24 hours a day so you can get a prescription filled in the middle of the night, if you need to.
How do I get over the counter medications?
Your UnitedHealthcare clinician needs to write an order on their prescription pad for over-the counter medications. Just bring the prescription and bring your UnitedHealthcare identification card to a participating pharmacy to get your OTC prescription filled. Examples of over-the counter-medications include aspirin, cough syrup, condoms and much more. These medications are available to you at no cost.
What is a formulary?
A formulary is a list of medications that UnitedHealthcare will pay for when ordered by your doctor. UnitedHealthcare has a large formulary. Some drugs require that your doctor get prior approval by UnitedHealthcare. Your doctor may contact us for more information about coverage or visit our website for our formulary.
How is the RIte Care and Rhody Health Partners/Children with Special Health Care Needs Formulary (Prescription benefit) different?
All Medicaid members must use generic drugs first. Generic drugs may require prior authorization. There are a limited number of brand name drugs that will be covered. These will be limited to certain classes (or types) of drugs. Additionally, some of these may require prior authorization by UnitedHealthcare. If you feel you that you are unable to take the generic medication, please contact your provider. Health plan providers are aware of the criteria for approval of brand name drug coverage.
How do I get injectable medications?
Injectable medications are covered under the medical benefit. Your doctor can make arrangements to have the injectable medication delivered, either to his/her office or your home. In some instances your doctor will write you a prescription for injectable medication (i.e. insulin), which can be filled at a pharmacy.
Do I have co-pays for prescriptions?
Most UnitedHealthcare RIte Care and Rhody Health Partners members do not have copays. Check your benefit summary to see if you have a co-pay.
How do I access my mental health benefits?
To access your Behavioral Health benefits please call United Behavioral Health at 800-435-7486 and an intake specialist will assist you. For the hearing impaired, please call 711.
What if a doctor, lab or clinic sends me a bill?
If you get a bill call Member Services at 1-800-587-5187 or Hard of Hearing 711. A representative will work with you to find out if you need to pay the bill or if you should send it to us.
Do I need to let UnitedHealthcare know if I become pregnant or have a baby?
Yes. First contact your local Department of Human Service (DHS) office. Second call Member Services at 1-800-587-5187, open 24 hours a day, 7 days a week.
Are there a minimum number of hospital days that UnitedHealthcare will cover if I have a baby?
Yes. UnitedHealthcare is required by law to cover a minimum hospital stay of 48 hours after a vaginal birth and 96 hours after a caesarean birth, unless the mother requests an early discharge.
Do I have to pay a premium?
RIte Care Members: You may have to pay a premium for your medical assistance depending on you or your family’s income. A premium is an amount you pay every month to receive health care benefits through Medical Assistance. The payment is made to Medical Assistance not to UnitedHealthcare. You will be notified by the RI Department of Human Services if you are subject to a monthly premium.
What if my children or I have other health insurance?
If you have RIte Care the other health insurance company will pay your health care bills first. When you receive care, always show both cards (your insurance card and your UnitedHealthcare RIte Care Insurance card.) If you have Rhody Health Partners or RIte Care and become eligible for other insurance please notify the Rhode Island Department of Human Services.
What if my family size changes?
Notify your local Department of Human Service office and Member Services at 1-800-587-5187 or Hard of Hearing 711 (24 hours a day 7 days a week).
Does the Health Plan require that I get a second opinion for any services?
No. UnitedHealthcare does not require you to get a second opinion for covered services. However a second opinion is available to you at no cost for all medical, surgical, and other healthcare covered services.
What benefits are not covered by my health plan?
The following services are not covered by UnitedHealthcare:
- Experimental procedures, except where a state mandate for coverage exists
- Abortion services, except to preserve the life of the women or in case of rape or incest.
- Private rooms in hospitals (unless medically necessary)
- Cosmetic surgery
- Infertility treatment services
- Sexual and erectile dysfunction medications
Services outside Rhode Island are not covered unless the provider is participating with UnitedHealthcare New England's Medicaid plan, or with an authorization if a covered benefit is not available in network.
RIte Care and Rhody Health Partners Members:
Services outside of United States territory (emergency and non-emergency) are not covered. Emergency Services are covered within the 50 United States. If you have an emergency go to the closest emergency room.
What is our mailing address?
UnitedHealthcare of New England, Inc.
Medicaid Department
475 Kilvert Street
Warwick, RI 02886-1392
What is Medicaid?
Medicaid is a program for people with low income who meet certain eligibility requirements and programs can vary from state-to-state.
What documents will I need when I apply for Medicaid?
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
