Expansion of UnitedHealthcare musculoskeletal management benefit programs

Musculoskeletal conditions affect more than half of U.S. adults.1 They also represent 12% of all UnitedHealthcare medical expenses and continue to represent one of the top clinical cost drivers for our clients.2

Low back pain benefit
Employees with new-onset low back pain will have access to 3 network physical therapy or chiropractic visits per plan year at no additional cost to them. To be eligible, employees must have physical therapy or chiropractic benefits remaining – these benefits do not extend the employee’s physical therapy or chiropractic benefit maximum.

Advantages of low back pain benefit utilization:

  • Early treatment may provide pain relief and help prevent chronic pain.
  • 3 lower back care network visits are covered at $0 out-of-pocket.
  • 6-times lower probability of surgery if member chooses a conservative path of care first.3  

Beginning July 1, low back pain benefit changes that were previously introduced in other markets will be expanded to include 24 additional large group markets. These benefit changes apply to UnitedHealthcare, fully insured large business customers.

Large group expansion
Low back pain benefit changes will be embedded in the following products for all new and renewing Large Business (51+) customers in the markets listed below with effective dates on or after July 1, 2021. 

Market Product Availability
Delaware Choice/Choice Plus, Core/Core Essential, Select/Select Plus, Heritage/Heritage Plus, Heritage Select/Heritage Select Plus
Illinois Choice/Choice Plus, Core/Core Essential, Heritage/Heritage Plus, Heritage Select/Heritage Select Plus
Indiana Choice/Choice Plus, Core/Core Essential
Iowa Choice/Choice Plus, Heritage/Heritage Plus, Heritage Select/Heritage Select Plus
Kansas Choice/Choice Plus
Kentucky Choice/Choice Plus
Maine Choice/Choice Plus
Massachusetts Choice/Choice Plus
Michigan Choice/Choice Plus, Core Essential
Minnesota Choice/Choice Plus, Core/Core Essential
Missouri Choice/Choice Plus, Core/Core Essential
Nebraska Choice/Choice Plus
New Hampshire Choice/Choice Plus
North Dakota Choice/Choice Plus
Ohio Choice/Choice Plus, Heritage/Heritage Plus
Oklahoma Choice/Choice Plus, Select/Select Plus
Pennsylvania Choice/Choice Plus
Rhode Island Choice/Choice Plus
South Dakota Choice/Choice Plus
Texas Choice/Choice Plus, Core/Core Essential
Virginia Choice/Choice Plus, Core/Core Essential
Washington D.C. Choice/Choice Plus, Core/Core Essential
Wisconsin Choice/Choice Plus
West Virginia Choice/Choice Plus

The low back pain benefit changes are available nationally for self-funded (ASO) groups on an opt-in basis. They are also available to large business, fully insured groups in various markets. 

Orthopedic Health Support (OHS) program 
This combined offering of orthopedic clinical management and UnitedHealthcare’s Center of Excellence (COE) surgical network is available for one price and provides members with access to specialized nurses and quality providers that address needs from early pain onset through treatment and beyond. Through a single point of contact, members receive help navigating the health care system, assessing care options and finding the right provider. 

New and renewing fully insured UnitedHealthcare large group (51+) customers with effective dates on or after July 1, 2021, will be able to purchase the OHS program. This program has been available for National Accounts and Key Accounts self-funded (ASO) customers to purchase since January 2021. Existing groups can purchase upon their renewal date.

Physical Health Solutions 
Created to offer choice, quality and consistency, and is designed to help improve outcomes and lower costs for members with musculoskeletal (MSK) conditions through: 

  • Physical health networks – the actual networks of chiropractors and physical, occupational and speech therapists.
  • Complementary and alternative medicine services (CAMS) such as acupuncture, massage therapy and naturopathic medicine. Some medical benefit plans do not cover acupuncture and/or massage therapy services or a member may have exhausted the benefit. In those instances, there is a CAMS discount of up to 20% available. 
  • Physical Health Clinical Support Program – A care management component that includes provider clinical submission, information collection, provider data sharing, peer-to-peer outreach, case-specific outreach and education/support. 

The Physical Health Solutions program is embedded for all fully insured and ASO, Key Accounts and Small Business UnitedHealthcare, Oxford and UMR customers. UMR customers only have access to the network and not the clinical support program. 

For additional information please contact your UnitedHealthcare representative.  

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