Thursday, June 24, 2010

UHC Shared Savings Program change for fully insured groups

In the past, members who received services from non-network facilities, doctors or other health care professionals could see their claims reimbursed by one of two programs: either receiving discounted rates for those services though UHC’s Shared Savings Program or rates determined by a Medicare-based reimbursement methodology under UHC’s Maximum Non-Network Reimbursement Program (MNRP).

Effective August 1, the Shared Savings Program through UnitedHealthcare (UHC) will no longer provide discounts for certain non-network facility claims for fully insured plans. Claims that will no longer be eligible for the Shared Savings discounts are those that are eligible for adjudication under MNRP.

According to UHC, this change will help decrease costly non-network utilization and better manage rising health care costs for UHC customers. Shared Savings discounts will continue to be applied to claims from non-network doctors and other health care professionals where available.

These program changes do not affect whether a claim is paid at the network or non-network benefit level. Additionally, emergency and approved network gap facility claims will not be subject to MNRP processing and will continue to be processed at the network benefit level.

Member Impact
Less than 0.2% of UHC’s fully insured membership is expected to be affected by this change; however, those members who choose to use non-network facilities may experience higher out-of-pocket costs due to potential balance-billing by those facilities.

Members that used the same non-network Shared Savings Program facility two or more times in the last six months will receive a letter in June notifying them of these upcoming changes. The letter highlights the potential for increased out-of-pocket costs if they continue to receive services at non-network facilities.

For more information on MNRP, please click to view UHC’s Maximum Non-Network Reimbursement Program Summary.

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