This Mid-Atlantic Regional supplement applies to services provided to members enrolled in:
MD-Individual Practice Association, Inc. (“M.D.IPA”) and M.D.IPA Preferred.
Optimum Choice, Inc. (“Optimum Choice”), and Optimum Choice Preferred, and Optimum Choice Small Business Health Options Program (SHOP).
It may apply to health care providers in Delaware, Washington, D.C., Maryland, Pennsylvania, Virginia and West Virginia; reference your Agreement for applicability.
Health care providers are subject to both the main guide and this supplement. This supplement controls if it conflicts with information in the main guide. For protocols, policies and procedures not referenced in this supplement refer to appropriate chapter in the main guide.
A complete list of Mid-Atlantic Health plan protocols pertaining to M.D.IPA, M.D.IPA Preferred, Optimum Choice, and Optimum Choice Preferred may be located on uhcprovider.com/plans > Choose Your State.
The term “prior authorization” referenced in this supplement is also referred to as “preauthorization.” We use both terms in this supplement. They mean the same.
The Optimum Choice and Optimum Choice Preferred HSA benefit plans are high-deductible medical benefit plans that combine our traditional gated HMO benefit plans with an HSA option. Expenses under this benefit plan are the member’s responsibility until their deductible is reached. HSA benefit plans require reimbursement for services provided to members are based on a fee-for-service reimbursement methodology.
Optimum Choice, Inc. Health Savings Account
The Optimum Choice HSA product requires each UnitedHealthcare member to choose a PCP.
PCP referrals to network specialists
The member’s PCP generates referrals for specialty care and facility care.
Services for members enrolled in Optimum Choice HSA are excluded from your capitation payment and are paid on a fee-for-service (FFS) basis per the All Payer Payment Appendix included in the UnitedHealthcare physician Agreement..