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Medicare Opt-Out - Chapter 2, 2018 UnitedHealthcare Administrative Guide

Medicare Opt-Out

We follow, and require our care providers to follow, Medicare requirements for physicians and other practitioners who opt out of Medicare. If you opt out of Medicare, you may not accept federal reimbursement.

Care providers who opt-out of Medicare (and those not participating in Medicare) are not allowed to bill Medicare or its Medicare Advantage (MA) benefit plans during their opt-out period for two years from the date of official opt-out. For our MA membership, we and our delegated entities do not contract with, or pay claims to, care providers who have opted-out of Medicare.

Exception: In an emergency or urgent care situation, if you have opted out of Medicare, you may treat a MA beneficiary and bill for the treatment. In this situation, you may not charge the member more than what a non-participating care provider is allowed to charge. You must submit a claim to us on the member’s behalf. We pay Medicare covered items or services furnished in emergency or urgent situations.