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UnitedHealthcare Community Plan Lookup Tools

Find A Provider

Search our directory of network physicians and facilities by providing additional information below.

UHC Community Plan of OH Find a Provider

Search for a Behavorial Health Provider

Ohio Department of Medicaid - Find a Provider

OhioRISE - please see below 

Your Primary Care Provider (PCP)

The main doctor you see is called a Primary Care Provider, or PCP. When you see the same PCP over time, it’s easier to develop a relationship with them. Each family member can have their own PCP, or you may all choose to see the same person. You will see your PCP for:

  • Routine care, including yearly checkups
  • Coordinate your care with a specialist
  • Treatment for colds and flu
  • Other health concerns

You have options

You can choose between many types of network providers for your PCP. Some types of PCPs include:

  • Family doctor (also called a general practitioner) — cares for children and adults
  • Internal medicine doctor (also called an internist) — cares for adults
  • Nurse Practitioner (NP) — cares for children and adults
  • Pediatrician — cares for children
  • Physician Assistant (PA) — cares for children and adults

What is a Network Provider?

Network Providers have contracted with UnitedHealthcare Community Plan to care for our members. You don’t need to call us before seeing one of these providers. Sometimes members need to see a very specialized type of doctor. We will work with your PCP to make sure you get the specialist or service when you need it, for as long as you need it, even if the provider is not currently a network provider. There is no cost to you when we authorize the care or service in advance, before you see the non-network provider.

If you see a specialist without being sent by your PCP and without UnitedHealthcare Community Plan authorization in advance advance, you may have to pay the bill. Always work with your PCP first for any services you need.

How to change your PCP

Member Services will help make sure that the PCP you want to switch to is a participating provider with UnitedHealthcare Community Plan. They will also check to be sure the PCP you want to switch to is accepting new patients. Members can change their PCP monthly. 

If you change during your first month of membership, you PCP change will be effective immediately. After your first month of membership, your PCP change will take effect the first day of the next month. We will send you a new ID card with your new PCP listed. We will also let you know when you can start seeing your new PCP. Download the PCP Change form. 

If you have questions? Visit myuhc.com/CommunityPlan or call Member Services at 1-800-895-2017, TTY 711.

UHC Community Plan of Ohio Provider Directories

OhioRISE

Provider Directory

You can request a printed copy of our provider directory. Just call Member Services at 1-833-711-0773 (TTY: 711).

You can also download a list of Child and Adolescent Needs and Strengths (CANS) providers.

The provider directory is also online at AetnaBetterHealth.com/OhioRISE. Click on the ‘Find a Provider’ ribbon on the top righthand side of the page. From there you can search behavioral health providers, specialists and facilities in your area.

The online provider directory gives the provider’s name, address, telephone numbers, professional credentials, specialty and board certification status.

If you want help finding a provider for any of our services, call Member Services at 1-833-711-0773 (TTY: 711). We will be happy to help you. You also can call Member Services if you want a provider to be added to our network. We will try to make that happen.

You may see an out-of-network provider if you need special care and we do not have a network provider with the right specialty. The provider must first get approval from us to see you, or you may be billed. See pages 13-15 of the Handbook on getting prior approval (prior authorization) for services.

If you are unable to leave your home

If you can’t leave your home to get care, we can help. Call Member Services at 1-833-711-0773 (TTY: 711). We will have a care coordinator work with you to make sure you get the care you need.

If you are experiencing a behaviroal health crisis, please call 1-877-542-9236 (TTY: 711). Calls are answered 24/7. Interpreter service is available.

Search for a behavorial health provider.

OhioRISE

Mobile Response and Stabilization Services (MRSS) is covered by OhioRISE. It provides rapid in-person care when a child or youth is experiencing significant behavioral or emotional distress. It’s available 24 hours a day, 365 days a year, and is delivered in the home, school, or at another location in the community.

This service is available to any child or youth covered by Ohio Medicaid. Call the Ohio CareLine at 1-800-720-9616 to reach the MRSS in your community.

Download a copy of the MRSS provider directory. 

Ohio Community Plan Drug Information

Search for drugs covered by UnitedHealthcare Community Plan

Drug Lists

Brand and/or generic may be excluded from coverage. Lower-cost options are available and covered. Please see the 90 Day Supply Drug List for more information.

COVID 19 Test Kit Reimbursement Request Form

Direct Member Reimbursement Form

OhioRISE Information

Important Update on Prescription Benefits: Ohio Medicaid Single Pharmacy Benefits Manager

Your prescription benefits are provided by a Pharmacy Benefits Manager, or PBM. We partner with Ohio Department of Medicaid to provide this benefit, and on October 1, 2022, we will start to work with a new PBM, Gainwell.  Your pharmacy benefit will remain the same.

For questions about finding a pharmacy in the network, medications or prior authorization, contact Gainwell at spbm.medicaid.ohio.gov or contact them by phone at 1-833-491-0344

You can find Ohio Unified Preferred Drug List here: https://pharmacy.medicaid.ohio.gov/unified-pdl 

You can also access pharmacy information at the Ohio Department of Medicaid website here: https://pharmacy.medicaid.ohio.gov/ or https://medicaid.ohio.gov/families-and-individuals 

Find A Pharmacy

Search for a UnitedHealthcare network pharmacy below.

Search for a Pharmacy.

Due to State Law and Medicaid requirements, members must have a referral from their healthcare provider (physician, nurse practitioner, or physician assistant) before a pharmacist may provide drug therapy management services. The pharmacist must also have an active consulting agreement with the member’s healthcare provider before services may be rendered.

Important Update on Prescription Benefits: Ohio Medicaid Single Pharmacy Benefits Manager

Your prescription benefits are provided by a Pharmacy Benefits Manager, or PBM. We partner with Ohio Department of Medicaid to provide this benefit, and on October 1, 2022, we will start to work with a new PBM, Gainwell.  Your pharmacy benefit will remain the same.

For questions about finding a pharmacy in the network, medications or prior authorization, contact Gainwell at spbm.medicaid.ohio.gov or contact them by phone at 1-833-491-0344

You can find Ohio Unified Preferred Drug List here: https://pharmacy.medicaid.ohio.gov/unified-pdl 

You can also access pharmacy information at the Ohio Department of Medicaid website here: https://pharmacy.medicaid.ohio.gov/ or https://medicaid.ohio.gov/families-and-individuals 

Flu Vaccine Locator

Members can get their flu vaccine at the following pharmacies

Drugs

If your doctor wants you to have a drug that is not on our list, your doctor can request it. Our pharmacy staff looks over the request within 24 hours and makes a decision.

  • If you need drugs right away, the pharmacist can fill a one-time, five-day supply of the drugs not on our Preferred Drug List.
  • If you take the drug on an ongoing basis, the pharmacist can fill a 15-day supply. The pharmacist will have to call UnitedHealthcare Community Plan's pharmacy department for approval.

Medical

In some cases your provider must get permission from the health plan before giving you a certain service. This is called prior authorization. This is your provider’s responsibility. If they do not get prior authorization, you will not be able to get those services.

View our list of services that require prior authorizations.


Individual & Family ACA Marketplace Plans Disclaimer
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The benefits described may not be offered in all plans or in all states. Some plans may require copayments, deductibles and/or coinsurance for these benefits. This policy has exclusions, limitations, reductions of benefits, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, review your plan documents, call or write your insurance agent or the company, whichever is applicable. Plan specifics and benefits vary by coverage area and by plan category. Please review plan details to learn more.

UnitedHealthcare Individual & Family plans medical plan coverage offered by: UnitedHealthcare of Arizona, Inc.; Rocky Mountain Health Maintenance Organization Incorporated in CO; UnitedHealthcare of Florida, Inc.; UnitedHealthcare of Georgia, Inc; UnitedHealthcare of Illinois, Inc.; UnitedHealthcare Insurance Company in AL, KS, LA, MO, NJ, and TN; Optimum Choice, Inc. in MD and VA; UnitedHealthcare Community Plan, Inc. in MI; UnitedHealthcare of Mississippi, Inc.; UnitedHealthcare of New Mexico, Inc.; UnitedHealthcare of North Carolina, Inc.; UnitedHealthcare of Ohio, Inc.; UnitedHealthcare of Oklahoma, Inc.; UnitedHealthcare of South Carolina, Inc.; UnitedHealthcare of Texas, Inc.; UnitedHealthcare of Oregon, Inc. in WA; and UnitedHealthcare of Wisconsin, Inc.  Administrative services provided by United HealthCare Services, Inc. or its affiliates.

This policy has exclusions, limitations, reduction of benefits, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, call or write your insurance agent or the company, whichever is applicable. By responding to this offer, you agree that a representative may contact you.

1 Unless otherwise required, benefits are available only when services are delivered through a Designated Virtual Network Provider. Virtual visits are not intended to address emergency or life-threatening medical conditions and should not be used in those circumstances. Services may not be available at all times, or in all locations, or for all members. Check your benefit plan to determine if these services are available. Data rates may apply. Certain prescriptions may not be available and other restrictions may apply.

2 Tier 2 prescriptions for $5 or less not available on all medications. 3-month fills apply to select maintenance medications only. Applicable formulary requirements such as prior authorization and quantity limits may apply to your pharmacy benefits. Walgreens discount valid until 12/31/24. Discount valid only for in-store purchases of eligible Walgreens brand health and wellness products by current members eligible for the UnitedHealthcare discount program. Discount cannot be used online. For a full list of Walgreens brand health and wellness products and exclusions, please visit www.walgreens.com/smartsavings.

Last Updated: 04.18.2024 at 12:11 AM CDT

Disclaimer information
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Looking for the federal government’s Medicaid website? Look here at Medicaid.gov.

UnitedHealthcare Dual Complete plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. Benefits, features and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

Premium disclaimer

Dual Special Needs plans have a $0 premium for members with Extra Help (Low Income Subsidy).

Benefit disclaimer

Benefits, features, and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply.

Nurse Hotline disclaimer

This service should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. The information provided through this service is for informational purposes only. The nurses cannot diagnose problems or recommend treatment and are not a substitute for your provider's care. Your health information is kept confidential in accordance with the law. The service is not an insurance program and may be discontinued at any time. Nurse Hotline not for use in emergencies, for informational purposes only.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan)

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. 

UnitedHealthcare Connected® (Medicare-Medicaid plan)

UnitedHealthcare Connected® (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees.

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan)

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and MassHealth (Medicaid) to provide benefits of both programs to enrollees. 

UnitedHealthcare Connected® general benefit disclaimer

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the member handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® member handbook. 

UnitedHealthcare Senior Care Options (HMO SNP) plan

UnitedHealthcare Senior Care Options (SCO) is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare and does not have any other comprehensive health Insurance, except Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our Senior Care Options (SCO) program.

Star ratings disclaimer

Every year, Medicare evaluates plans based on a 5-Star rating system. The 5-Star rating applies to plan year 2024.

Important provider information

The choice is yours

We will provide you with information to help you make informed choices, such as physicians' and health care professionals' credentials. This information, however, is not an endorsement of a particular physician or health care professional's suitability for your needs.

The providers available through this application may not necessarily reflect the full extent of UnitedHealthcare's network of contracted providers. There may be providers or certain specialties that are not included in this application that are part of our network. If you don't find the provider you are searching for, you may contact the provider directly to verify participation status with UnitedHealthcare's network, or contact Customer Care at the toll-free number shown on your UnitedHealthcare ID card. We also recommend that, prior to seeing any physician, including any specialists, you call the physician's office to verify their participation status and availability.

Some network providers may have been added or removed from our network after this directory was updated. We do not guarantee that each provider is still accepting new members.

Out-of-network/non-contracted providers are under no obligation to treat UnitedHealthcare plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services.

American Disabilities Act notice

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 ("ADA"), UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

Referrals

Network providers help you and your covered family members get the care needed. Access to specialists may be coordinated by your primary care physician.

Paper directory requests

Paper copies of the network provider directory are available at no cost to members by calling the customer service number on the back of your ID card. Non-members may download and print search results from the online directory.

Inaccurate information

To report incorrect information, email provider_directory_invalid_issues@uhc.com. This email box is for members to report potential inaccuracies for demographic (address, phone, etc.) information in the online or paper directories. Reporting issues via this mail box will result in an outreach to the provider’s office to verify all directory demographic data, which can take approximately 30 days. Individuals can also report potential inaccuracies via phone. UnitedHealthcare Members should call the number on the back of their ID card, and non-UnitedHealthcare members can call 1-888-638-6613 / TTY 711, or use your preferred relay service.

Declaration of disaster or emergency

If you’re affected by a disaster or emergency declaration by the President or a governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, there is certain additional support available to you.

  • Part A, Part B, and supplemental Part C plan benefits are to be provided at specified non-contracted facilities (note that Part A and Part B benefits must be obtained at Medicare certified facilities);
  • Where applicable, requirements for gatekeeper referrals are waived in full;
  • Plan-approved out-of-network cost-sharing to network cost-sharing amounts are temporarily reduced; and
  • The 30-day notification requirement to members is waived, as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the member.

If CMS hasn’t provided an end date for the disaster or emergency, plans will resume normal operation 30 days after the initial declaration.