Skip to main content

Information for Employer-Sponsored and Individual Plans

Referrals and Authorizations 

Network providers help you and your covered family members get the care needed. Your plan may have limitations regarding accessibility, prior approvals for outpatient services or referrals from your primary care physician to see a specialist, as well as other restrictions imposed by your limited provider network. Access to specialists may be coordinated by your primary care provider.  Use the number on the back of your insurance card to confirm benefits or authorization and referral requirements.

State Specific Notices

California

For California Providers Only

Individual facilities or health care providers may disagree with the methodology used to define the cost ranges, the cost data, or quality measures. Many factors may influence cost or quality, including, but not limited to, the cost of uninsured and charity care, the type and severity of procedures, the case mix of a facility, special services such as trauma centers, burn units, medical and other educational programs, research, transplant services, technology, payer mix, and other factors affecting individual facilities and health care providers.

Pursuant to Section 1367.49 of the California Health and Safety Code and Section 10133.64 of the California Insurance Code, a provider or supplier may choose to provide an Internet Web link where a response to the health care service plan's cost and/or quality posting may be found.

Click links below for response:

When a provider no longer participates in the network, or has changed participation status, additional liability is likely to result. Soon after the provider changes their status, out of network penalties or increased cost sharing will result. In some cases, extension of in network or greater network benefits may be available.

Health Services from Non-Network Providers Paid as Network Benefits

If specific Covered Health Services are not available from a Network provider, you may be eligible for Network Benefits when Covered Health Services are received from non-Network providers. In this situation, your Primary Physician or other Network Physician will notify us and, if we confirm that care is not available from a Network provider, we will work with you and your Primary Physician or other Network Physician to coordinate care through a non-Network provider. If care is authorized from a non-Network provider because it is not available from a Network provider, you will be responsible for paying only the in-Network cost sharing for the service.

Limitations on Selection of Providers

Some hospitals and other providers do not provide one or more of the following services that may be covered under your policy and that you or your family member might need: family planning; contraceptive services, including emergency contraception; sterilization, including tubal ligation at the time of labor and delivery; infertility treatments; or abortion. You should obtain more information before you become a policyholder or select a network provider. Call your prospective doctor or clinic, or call the insurer at (insert the insurer's membership services number or other appropriate number that individuals can call for assistance) to ensure that you can obtain the health care services that you need.

Interpreter Services

Interpreter services will be coordinated with scheduled appointments for Covered Health Services in a manner that ensures the provision of interpreter services at the time of the appointment.

For California residents, for Behavioral health services and appointments, under California law, you may also be entitled to free interpretation services.  To get help in your language, please call 1-800-999-9585 or call the number on your member identification card. Language interpretation services are available at no cost to the member.

Timely Access to Care

Providers in our network are required to have appointment availability within specified time frames.

Appointment Type Timeframe

  • Urgent Care (prior authorization not required by health plan) 48 hours
  • Urgent Care (prior authorization required by health plan) 96 hours
  • Non-Urgent Doctor Appointment (primary care provider) 10 business days
  • Non-Urgent Doctor Appointment (specialty physician) 15 business days
  • Non-Urgent Mental Health Appointment (non-physician) 10 business days
  • Non-Urgent Appointment (ancillary provider) 15 business days

Behavioral health paper directory requests

Enrollees, potential enrollees, providers and members of the public may request a printed copy of providers in your area by contacting the Plan by phone, 1-800-999-9585; by email bnswest@optum.com;  or by mail: OptumHealth Behavioral Solutions of California P.O. Box 880609 San Diego, CA  92108.

Colorado

UnitedHealthcare has prepared and maintains a network access that describes how the plan monitors the network of providers to ensure that you have access to network providers. The access also has information on the referral processes, complaint procedures, quality programs and emergency services coverage provisions. The network access plan is available at the plan’s office: 6465 Greenwood Plaza Blvd, Suite 300, Centennial, CO, 80111 or call (800) 842-4509.

District of Columbia

Enrolling in this plan does not guarantee services by a particular provider on this list. If you wish to receive care from specific providers listed, you should contact those providers to be sure that they are accepting additional patients for this plan.

Hawaii

UnitedHealthcare Insurance Company Access Plan - Small GroupOpens a new window
UnitedHealthcare Insurance Company Access Plan - Large GroupOpens a new window

Louisiana

In some instances, a physician who performs services at a facility contracted by UnitedHealthcare may not himself have a contract with UnitedHealthcare. If a non-contracted physician renders service to you or a covered family member, you may experience higher out-of-pocket costs. To help you avoid these higher costs, the Louisiana Consumer Health Care Provider Network Disclosure Act requires that you have access to information on the network status of anesthesiologists, pathologists, radiologists, emergency medicine physicians and neonatologists at each of our contracted facilities. To access this information when doing a network facility search, start by clicking on the facility name. Thereafter, click on the 'Physician Directory' link and a list of contracted physicians at that facility will be displayed. Any physician the facility may use to treat you who is not on the list is likely to be non-participating with UnitedHealthcare. It is always good idea for you to ask the facility which physicians will be rendering services, and then contact those physicians directly to verify whether they participate with UnitedHealthcare. You can also call Customer Care at the toll-free number shown on your UnitedHealthcare ID card to obtain the same information.

Maryland

Referrals to Out-of-Network Providers due to Network Inadequacy

Massachusetts

Notice for fully insured Massachusetts members: Please be advised that this tool is not intended to be and should not be relied upon for purposes of obtaining cost estimates under MA S2400, signed into law on August 6, 2012. Fully insured Massachusetts members seeking a cost estimate for purposes of MA S2400 should instead contact the member services phone number listed on your health plan identification (ID) card.

Nevada

Nevada Recent Terminations

View Recently Termed Providers

New Jersey

View Percentage of in-network physicians that are board certified

New Mexico

For Native American plan members, HIS and 638 health facilities or other tribal health facilities will be included at in-network rates, even if they are not listed as part of the plan network.

Ohio

When a provider no longer participates in the network, or has changed participation status, additional liability is likely to result. Soon after the provider changes their status, out of network penalties or increased cost sharing will result. In some cases, extension of in network or greater network benefits may be available.

Oregon

In the event that the cost estimate differs from the actual cost of the procedure or service, and you would like an explanation or if you have additional questions, please contact our Customer Service Center at the number on your health plan ID card. If you need help with an insurance question or complaint, then you may contact the Consumer Advocacy Unit of the Oregon Department of Consumer and Business – Insurance Division at (888)877-4894 (toll free), P.O. Box 14480 Salem, OR 97309-0405, website: insurance.oregon.govOpens a new window, or email: cp.ins@state.or.us

Pennsylvania

We cannot guarantee continued access to a particular provider through the term of your enrollment in the plan.  If the provider that you are seeing ceases participating with your plan, we will provide access to other providers with equivalent training and experience.

The choice of a given provider as a PCP may result in access to a limited subnetwork of providers, based on the PCP’s employment or other affiliation arrangements.

Texas

Texas facility based physician contract status.

View Contract StatusOpens a new window

Texas Facility-based Non-contracted Physician Claims Information

View Non-Contracted Claims InformationOpens a new window

Pursuant to Texas Department of Insurance Title 28, Chapter 11, Subchapter Q, Section §11.1612 (f)(2), an HMO must provide a web-based listing indicating that the network meets or does not meet the network adequacy requirements.

View TX Network Adequacy Listing

View TX Network Adequacy Listing – Dental

Vermont

Behavioral Health – Provider Participation

Joining Our Network : Providers of mental health or substance use services not currently under contract with the managed care organization that are willing to meet the terms and conditions for participation may apply for contracted status and may become contracted after successful completion of credentialing. Please refer provider to providerexpress.com for further details.

Behavioral Health – Utilization Review

There are some services that are not guaranteed until the requirements for utilization review have been completed and documentation of authorization has been issued. Use the number on the back of your card to obtain information on how to seek authorization, if you (and/or your representative) believe the necessary care is not available from contracted providers; initiate a grievance if coverage has been denied, reduced, modified, or terminated; and obtain information concerning the potential consequences if authorization is not obtained.

Behavioral Health – Care Management

Complex Case Management Program: The Complex Case Management Program is for members who could be helped through more intensive coordination of services. This program is intended to help members with complex behavioral health conditions connect with needed services and resources. For additional information about the Complex Case Management Program, please call the number on the back of your insurance card.

View Complex Case Management Program

Washington

Telemedicine may be available through your provider. Please contact your provider to determine what telemedicine services may be available.

Wisconsin

You are strongly encouraged to contact us to verify the status of the providers involved in your care including, for example, the anesthesiologist, radiologist, pathologist, facility, clinic or laboratory, when scheduling appointments or elective procedures to determine whether each provider is a participating or nonparticipating provider. Such information may assist in your selection of provider(s) and will likely affect the level of co-payment, deductible and amount of co-insurance applicable to care you receive. The information contained in this directory may change during your plan year. Please call the Customer Service phone number on your ID card to learn more about the participating providers in your network and the implications, including financial, if you decide to receive your care from nonparticipating providers.

Native Language Assistance

Where can I find plan information in my native language?

Looks like your browser is a little out-of-date.

Experience uhc.com at its fullest by upgrading to a newer version of one of these browsers: