Thursday, March 15, 2012

Advance notice protocol announced for UHC commercial clients

With a goal of helping members make informed decisions and control their out-of-pocket healthcare costs, beginning April 1, 2012, participating physicians and other health care professionals are required to discuss with UnitedHealthcare members, prior to rendering services, the option to use a participating provider of the provider types or for the services listed below:
  • Ambulatory Surgery – free-standing and hospital outpatient settings
  • Home Health
  • Laboratory Services – for specimens collected in the physician’s office and sent to a non-participating laboratory for processing
  • Outpatient dialysis
  • Specialty drug vendors
The physician or other health care professional must also complete the Member Advance Notice Form and obtain the member’s signature on the form, prior to rendering services, to confirm the member’s decision to receive services from a non-participating provider. A separate Member Advance Notice Form must be completed for each provider type or service listed above. Members who have out-of-network benefits can continue to exercise their right to use their benefits at any time.

This protocol does not apply in emergent situations. Also, this protocol does not apply when the participating provider or member has obtained an in-network exception to utilize a non-participating physician, facility or other health care provider.

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