Have you received a call from UnitedHealthcare?
If you have a chronic health condition, there are free programs and resources available to you through your HealthSelect plan. Unfortunately, many HealthSelect members don’t know these programs exist and are missing some great resources. UnitedHealthcare nurses are calling members to make sure they know of the services that could help them. We ask that you answer the call or call us toll-free at (866) 336-9371 (TTY users call 711) to get more information on these resources. To learn more about these calls click here.
HealthSelect network of physicians is growing
In the last six months, 910 primary care physicians (PCP) and 2,289 specialists have joined the UnitedHealthcare HealthSelect network. It’s important to have a network PCP, as he or she can help manage your care and issue referrals to see a specialist. Also, when you see network physicians and specialists, you receive network benefits, which can help minimize your out-of-pocket costs that may be incurred. To search for a network physician near you, click here.
Diabetic Supplies are covered under the HealthSelect plan and can be obtained through mail order when using one of the following providers:
If diabetic supplies are purchased from a retail pharmacy, the participant will need to submit a paper claim form along with the bill or receipt to UnitedHealthcare. Please be sure that the diagnosis code, procedure code, date of service and cost are included to ensure timely processing of the claim. The claim form can be obtained here or by logging into your online personal account here. Once logged in, you can then access the Claims & Accounts tab.
The HealthSelect plan requires that you get a referral from your PCP (Primary Care Physician) to a Specialist for network benefits to apply. You are able to view referrals submitted by your PCP by logging into your online account. The PCP must use the online referral process in order for the referral to show in your account. Any referrals submitted by paper or transferred from the prior carrier cannot be viewed through your online account. Please contact HealthSelect Customer Care toll-free at (866) 336-9371 to inquire about any referrals that are not showing on the personal online account.
An explanation of benefits (EOB) statement is a resource that gives you information on the cost of your healthcare office visit, procedures, and items purchased (like durable medical equipment). The EOB provides the total charge, the amount HealthSelect paid, the amount not applicable to a HealthSelect member, and the amount you may be responsible for paying. The EOB also contains other helpful information, like out-of-pocket balances. We’ve developed a quick EOB training to help better explain this resource.
You will receive your EOB by mail, unless you created your online account and choose to receive electronic statements. EOBs for preventive care are not mailed, but are accessible through your HealthSelect online account or by calling HealthSelect Customer Care.
Starting January 1, 2013, Medicare-enrolled retirees and dependents will have a new prescription drug program called HealthSelect Medicare Rx managed by SilverScript. If you are eligible for HealthSelect Medicare Rx and decline enrollment, you will not have any prescription drug coverage through ERS. Retirees and dependents not eligible for HealthSelect Medicare Rx managed by SilverScript will continue coverage in the HealthSelect Prescription Drug Program managed by Caremark. For questions about HealthSelect Medicare Rx, contact SilverScript toll-free at (855) 344-0938 (TTY 711) or visit the HealthSelect Medicare Rx website.
The benefit booklets recently provided at benefit fairs and through the mail require a clarification to the benefit for routine physicals, well-woman exams, routine eye exam for children. The routine eye exam for children when provided as part of a preventive visit is considered a vision screening and would not be considered as a routine eye exam as provided by an optometrist or ophthalmologist. This will be amended in benefit booklets going forward to indicate vision screenings instead of routine eye exam for children to better define the service which is performed as part of preventive care. A routine eye exam for children will be covered as defined under the benefit for routine eye exam for adults.
HealthSelect is waiving the referral requirements for members who have been affected by Hurricane Sandy and need to access benefits. Please call HealthSelect customer service toll-free at (866) 336-9371 for more information.
It’s important to use network providers whenever possible. Quest Diagnostics (a lab provider) is not a HealthSelect network provider as of September 1, 2012. If you use a non-network provider you will pay more including a deductible, higher coinsurance, and all of the charges not covered by insurance. For a list of network labs and other providers, click here.
Did you receive a new HealthSelect medical ID card?
Show your new medical ID card to your health care providers starting September 1, so that they can update their records with your new identification number, new group number, the type of network and other information, as well as know how to bill for the services they are providing to you. If you have not received your card by September 5, or if you have questions about your new card, call us toll-free at (866) 336-9371.
If you or a covered dependent has in-area benefits and see a provider on or after September 1, 2012, who is not in the UnitedHealthcare network on the date of your appointment, you will receive non-network benefits for those services. An exception to this rule is if you are eligible for Transition of Care benefits.
Transition of Care allows you and your covered dependents to continue to see your non-network provider under UnitedHealthcare and receive network benefits for certain services until treatment is complete, your provider joins the new HealthSelect network under UnitedHealthcare, or November 30, 2012, whichever comes first. Transition of Care benefits for services like a transplant or terminal illness may be extended beyond November 30, if approved by HealthSelect.
If at least one of the following conditions applies to you and/or your covered dependents, complete the Transition of Care form found on the Publications and Forms section at www.healthselectoftexas.com and return it to UnitedHealthcare at the address provided on the form by September 30, 2012. You do not need to complete this form if your provider is in the UnitedHealthcare network.
The types of conditions that may be eligible for Transition of Care benefits include:
Mental Health and Substance Abuse treatment may also be eligible for Transition of Care benefits. If you and/or your covered dependent are receiving ongoing mental or behavioral health treatment at a non-network provider on or after September 1, click here for more information or call United Behavioral Health Solutions toll-free at (855) 802-7093 by September 30, 2012.
Many primary care physicians (PCP) have joined the UnitedHealthcare HealthSelect network in the last few months. You may have received a letter from UnitedHealthcare stating that your current PCP was not in the network. You may want to check if that information is still correct, since your doctor may have decided to join the network, or was in the process when the letter was sent. It can take up to 60 days to complete the qualification and review process to join the network. You can get the most current information on network providers by using the provider search tool or calling the dedicated HealthSelect service center operated by UnitedHealthcare toll-free at (866) 336-9371 (TTY users call 711).
If you have a PCP selected, please verify your current PCP is in the UnitedHealthcare network by using the Provider Search tool or calling us toll-free at (866) 336-9371 (TTY 711). If your PCP is not in the UnitedHealthcare network, you may want to designate a new PCP during Annual Enrollment to receive network benefits for medical services received September 1, 2012 and after. We will also send you a letter this summer to let you and your covered dependents know if you have a PCP selected and if that PCP is in the UnitedHealthcare network. If your current PCP is not in the UnitedHealthcare network or you have not designated a PCP, you may receive a call from UnitedHealthcare to help you with designating a network PCP.
Starting September 1, 2012, HealthSelectSM of Texas will be administered by United HealthCare Services, Inc. UnitedHealthcare will process claims, provide customer service, offer health and wellness programs, and manage the HealthSelect network starting September 1, 2012. Your prescription drug benefit is not changing as part of this transition. Caremark will continue to manage the HealthSelect prescription drug program.