Skip to main content

UnitedHealthcare Community Plan - Frequently Asked Questions

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.


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.

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.


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.

Yes, we can speak to members in over 130 different languages.

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.


Disclaimer information

(scroll within this box to view)

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

UnitedHealthcare Dual Special Needs 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. Benefits, features and/or devices may vary by plan/area.

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. Access to this service is subject to terms of use.

Star ratings disclaimer

Every year, Medicare evaluates plans based on a 5-Star rating system. The 5-Star rating applies to plan year 2026.

Formularies

The formulary, pharmacy network and provider network may change at any time. You will receive notice when necessary.

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.

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.