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Medicaid is a program for people with low income who meet certain eligibility requirements and programs can vary from state-to-state.
To qualify for Medicaid, potential members or their children must:
You or the member may call Customer Service toll-free at 1-888-980-8728 (TTY/TDD: 711) to request a printed copy of the formulary, or you may visit this link: Search for drugs covered by UnitedHealthcare QUEST Integration Program
When applying for services, potential members will need to take or mail (if available) the following documents:
If a member has a medical emergency:
If, while temporarily outside the Plan’s service area, and the member requires urgently needed care, then the member may get this care from any provider. The plan is obligated to cover all urgently needed care at the cost-sharing levels that apply to care received within the Plan network.
A referral is from your PCP for you to see a specialist to get services. A referral is not needed when you see any specialist that is in our network that your PCP referred you to. You do not need a referral for the following services:
• Emergency Services
• Women’s health care services, including yearly exams, pap smears, breast exams and birth control
• Behavioral health services, such as counseling or treatment for alcohol and drug use
• Covered family planning services
You may need approval or permission to get some services under our plans. This is called a prior authorization. Your PCP will work with us to get prior authorization if needed.
You do not need a prior authorization for emergencies.
You do not need it to see a women’s health provider for women’s health or if you are pregnant.
Some services that need a referral will also need a prior authorization.
UnitedHealthcare Community Plan QUEST Integration Program
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