Thursday, February 17, 2011

UnitedHealth Premium Physician Designation Refresh Effective March 30

Each year, all eligible network physicians in UnitedHealth Premium® designated specialties are evaluated to determine if they meet national standards for quality and local market benchmarks for cost efficiency. These updates are intended to continually enhance the UnitedHealth Premium program to promote access to quality and affordable health care.

Enhancements to the 2011 Premium program include:
• A more robust methodology and higher quality standards.
• The addition of seven new markets in Texas, New York, Minnesota, North Dakota, South Dakota and Western Wisconsin.
• Removal of Cardiovascular Surgery as a designated specialty.

These changes will be effective on Wednesday, March 30 on® and in other provider directories.

What Is the Impact of These Changes?
In some markets, these changes to the methodology will result in a slight increase in the number of designated physicians. Some markets will see a small decrease in the number of designated physicians and an even smaller number of markets will see a more dramatic decrease in the number of designated physicians.

There are some UnitedHealthcare medical plan designs like UnitedHealthcare EDGE and Tiered Benefits that enable members to pay lower copay and lower coinsurance percentages when they use a two-star quality and cost efficiency designated specialist. Because the designation status of an individual physician may have changed, it is important for any member who is seeking services from 2-star quality and cost efficiency designated specialists to confirm the designation status of their provider prior to the date of service by visiting or calling the Customer Care number on the back of their health plan ID card.

To minimize the impact of these changes to members, there will be a 90-day claims grace period for fully insured customers which will honor current two-star designations for claims payments. Self-funded customers may also request the 90-day claims grace period, if desired. UHC understands that patients may want to switch care from physicians who are no longer designated. In the past, UHC has allowed a 30-day grace period to facilitate the transition of care. This timeline has been extended to 90 days to reflect the greater number of patients who may be affected in certain markets.

Member Notification
UHC will be mailing a postcard notification to fully insured EDGE and Tiered Benefit subscribers informing them of the designation update later this month. A poster (color and black/white options) and email template are available for you to download below to help inform employees about this important update.
Member postcard notification
Member poster color option
Member poster black and white option
Member email

For the full news release from UHC, click to view the UHC Special Edition.

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