Enrollee and Provider Leaflet (Deeming Information) - Uhcretiree.com

Enrollee and Provider Leaflet (Deeming Information)How To Access Care from ProvidersBefore enrolling in UnitedHealthcare ®MedicareDirect ȘM or when you first seek health careservices and treatments after enrolling, you shouldtake this leaflet to your doctor, specialist or hospital.The information on the other side of thisleaflet will help them understand yourUnitedHealthcare ® MedicareDirect SM planand guide them in providing you withcovered services.1. As a UnitedHealthcare ® MedicareDirect SMenrollee, you may obtain covered servicesfrom any Medicare‐eligible provider anywherein the United States who agrees to accept ourTerms, Conditions and payment rate.If a particular health care provider doesn’taccept our Terms, Conditions and payment rate,you must get care from another provider whowill, unless it is an emergency. If you needassistance locating another provider, you maycontact Customer Service at the phone numberbelow. In an emergency, providers must treatyou, bill UnitedHealthcare ® MedicareDirect ȘMaccept our payment and only bill you forapplicable copayment or coinsurance.2. Each time you seek health care servicesand treatments, you need to present yourUnitedHealthcare ® MedicareDirect SM IDcard to be sure your health care providersare aware before providing services toyou that you are a UnitedHealthcare ®MedicareDirect SM enrollee.This is important because under the Medicarerules, providers have a right each and everytime they see you to decide if they will acceptthe UnitedHealthcare ® MedicareDirect SM Planand our Terms, Conditions and payment rate.Some providers, even Medicare providers, maychoose not to accept this plan. A providerwho accepts our Terms and Conditions isknown as a Deemed Provider.3. When a provider chooses to providecovered services and be a Deemed Provider,he or she must bill UnitedHealthcare ®MedicareDirect ȘM not Medicare.Any copayment for covered services can bepaid to your provider at the time of serviceand providers may bill you later for anyapplicable coinsurance amounts.Should you have any questions about how to access providers or their services, please callCustomer Service at 1-877-246-4190 (TTY 1-800-955-8771)from 8 a.m. to 8 p.m. local time, Monday through Friday.For more information about Private Fee‐For‐Service Plans, you can also refer to the Beneficiary Q&A at theCenters for Medicare & Medicaid Services’ (CMS) Web site, http://www.cms.hhs.gov/PrivateFeeforServicePlans/.SecureHorizons MedicareDirect, a Medicare Advantage Private Fee-For-Service Plan, is offered by United HealthCare InsuranceCompany or an affiliated company, a Medicare Advantage Organization with a Medicare contract.A Medicare Advantage Private Fee-For-Service plan works differently than a Medicare supplement plan. Your doctor or hospital is notrequired to agree to accept the plan’s terms and conditions, and thus may choose not to treat you, with the exception of emergencies.If your doctor or hospital does not agree to accept our payment terms and conditions, they may choose not to provide health careservices to you, except in emergencies. Providers can find the plan’s terms and conditions on our Web site at: www.uhcretiree.com.M0011_070810LS03(09/07)UHEX09PF3071659_000

Attention Health Care Provider:UnitedHealthcare ® MedicareDirect SM is a Medicare Advantage Private Fee-For-ServicePlan offered by United HealthCare Insurance Company or an affiliated company, undera contract with the Centers for Medicare & Medicaid Services (CMS).Participation is Easy!There is no contract to sign and no network to join.There are no prior authorization or pre-certificationrequirements. Private Fee-For-Service plans, whichdo not utilize contracts, are required by CMSregulations to pay providers the equivalent of whatproviders would have received under OriginalMedicare, less the enrollee’s financial responsibility.Overview of Plan Requirementsn Patients who enroll with our plan are requiredto inform you in advance of receiving coveredservices that they have coverage throughUnitedHealthcare ® MedicareDirect ṢMn You have the right to decide, on a patient-bypatientand visit-by-visit basis, whether to treatUnitedHealthcare ® MedicareDirect SM enrollees.n Before furnishing covered services, you musteither know our Terms and Conditions ofparticipation or have the opportunity to accessthem. Complete details about the plan, Termsand Conditions and administration can be foundat www.uhcretiree.com.n Once you are so informed, by furnishing servicesand by submitting a claim, you are agreeingto accept the Terms and Conditions includingpayment rate. Providers who accept the Termsand Conditions are called Deemed Providers.n If you do not agree to our Terms and Conditions,you may not render services to the enrollee andhe or she must find another provider, except in anemergency. In an emergency, you must treat theenrollee, bill UnitedHealthcare ® MedicareDirect ȘMaccept our payment and only bill the enrollee forapplicable copayment or coinsurance.Terms and ConditionsYou can review our Terms and Conditions and learnmore about UnitedHealthcare ® MedicareDirect ȘMincluding our billing requirements, on ourWeb site at www.uhcretiree.com or call the phonenumber below.Our Terms and Conditions include, but are notlimited to the following:n You agree to bill UnitedHealthcare ®MedicareDirect ȘM rather than Medicare, forreimbursement of covered health care services.n You agree to collect any share of cost(copayments/coinsurance) from our enrolleeas identified in the enrollee’s plan Summary ofBenefits or Evidence of Coverage, Section 10.You may collect any applicable copayment at thetime of service and then bill the enrollee for anyapplicable coinsurance.n You agree not to balance bill the enrollee forany amounts in excess of what you are paidby UnitedHealthcare ® MedicareDirect SM andthe enrollee, which together are equivalentto what you would have received underOriginal Medicare.n You may at any time, on a patient-by-patientand visit-by-visit basis, decide that youdo not want to treat a UnitedHealthcare ®MedicareDirect SM enrollee.n We will follow CMS requirements for timelypayment of claims.If you have questions, contactUnitedHealthcare ® MedicareDirect SMProvider Service at 1-866-579-8811from 8 a.m. to 8 p.m. local time, 7 days a week.We will be happy to answer your questions and provide any information you need. We look forward toworking with you and thank you for providing care to our UnitedHealthcare ® MedicareDirect SM enrollee.For more information about PFFS plans, see the Provider Q&A and the BeneficiaryQ&A at the CMS Web site http://www.cms.hhs.gov/PrivateFeeforServicePlans/.UHEX09PF3071659_000M0011_070810LS03(09/07)