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UnitedHealthcare Community Plan Frequently Asked Questions


If you do not have a ride to get medical care and services, UnitedHealthcare Community Plan may provide FREE transportation for you. If there is a bus service near you, you may be asked to use it unless there is a medical reason you can not 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.

UnitedHealthcare Community Plan has no copays for any covered services.


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.

 

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.


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


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.

Yes.  Chiropractic care visits are covered from any participating Chiropractor for subluxation of the spine.


Yes, you may see a UnitedHealthcare Community Plan Podiatrist for these services.


You do not need to be sent by your PCP to see a UnitedHealthcare Community Plan mental health provider. You can call 1-800-903-5253 for a provider near you. 

For members 21 years or older, your UnitedHealthcare plan covers a wide range of dental treatments and services. These services include preventative, diagnostic and minor restorative and oral surgery. Orthodontia is not a covered service.  Some Dental Services require "prior authorization" or approval before getting the services.

Here are some dental providers you may see:

  • General Dentist — Treats adults
  • Endodontist — Specializes in saving teeth; they do root canals
  • Periodontist — Provides treatment for gum disease
  • Oral Surgeon — Performs dental surgery, including difficult extractions
  • Dental Hygienist — Cleans teeth and provide oral health education
  • Dental Assistant — Assists the dental provider during treatment


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

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.

UnitedHealthcare Community Plan's formulary is a listing of medicines that we cover. UnitedHealthcare Community Plan participates in the Michigan Medicaid Common formulary of Medicaid covered drugs.

No, prescriptions are covered in full. There are no copays for any covered services through UnitedHealthcare Community Plan.


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 when it is medically necessary and your doctor writes a prescription for you.

You do not need to be sent by your PCP for FREE routine eye services. Eye exams, designer type frames and prescription lenses are covered when you see a UnitedHealthcare Community Plan -MarchVision provider. Routine eye exams, certain frames and lenses are covered every 24 months.  Replacement frames and lenses are covered once every 12 months for adults and twice every 12 months for children.

When you enroll with UnitedHealthcare Community Plan, we will send you an ID card too. Take both cards 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.


If you currently receive Medicaid benefits you can call Michigan Enrolls at 1-888-367-6557 and request enrollment with UnitedHealthcare Community Plan.

No, we currently do not offer commercial policies.


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.

Yes, you may choose a different HMO plan for family members.

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.

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


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.


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: 04.02.2024 at 07:10 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.