UnitedHealthcare Community Plan of Nebraska will comply with the following care provider marketing guidelines requirements:
UnitedHealthcare Community Plan of Nebraska will obtain and keep on file your written consent when conducting any form of marketing in your office. We will not require you to distribute health plan-prepared marketing communications to your patients. We will not provide you with incentives or giveaways to distribute to (potential) health plan members.
We will not allow you to solicit enrollment or disenrollment in a health plan, or distribute health plan-specific materials at a marketing activity. We will not provide printed materials to you with instructions about how to change health plans to other health plan members. We will instruct you about the following communication requirements:
If you wish to inform your patients of your affiliation with one or more health plans, you must list each health plan with whom you contract.
You may display or distribute health education materials for all contracted health plans, or you may choose not to display or distribute for any contracted health plan.
Health education materials must adhere to the following guidelines:
Health education posters can be no larger than 16 x 24 inches.
Children’s books, donated by us, must be in common areas.
Materials may include our name, logo, telephone number and website address.
You are not required to distribute and/or display all provided health education materials from each health plan with whom you contract.
You can choose which items to display as long as you distribute items from each contracted health plan, and that the distribution and quantity of items displayed are impartial.
You may display Managed Care Organizations (MCOs) marketing materials, provided that appropriate notice is conspicuously and equitably posted, in both size of material and type set, for all health plans with whom you have a contract.
You may display health plan participation stickers, but if you do you must display stickers for all contracted health plans, or choose not to display stickers for any contracted health plans.
Health plan stickers indicating that you participate with a particular health plan cannot be larger than 5 x 7 inches and cannot indicate anything more than “the health plan is accepting or welcomed here”.
You may inform your patients of the benefits, services and specialty care services offered through the health plans in which you participate. However, you may not recommend one health plan over another, offer patients incentives for selecting one health plan over another, or assist the patient in deciding to select a specific health plan in any way, including but not limited to faxing, using the office phone, or a computer in the office.
Upon health plan contract termination, if you contract with other health plans you may notify your patients of the change and the impact of the change on them, including the contract termination date. You must continue to see current patients enrolled with us through the termination date, according to all terms and conditions specified in your Agreement.
We will not produce branded materials instructing members about how to change to a different health plan. You must use MLTC-provided or approved materials and refer members directly to the enrollment broker for needed assistance.
Member Rights and Responsibilities
Members have the right to:
Request information on advance directives.
Be treated with respect, dignity and privacy.
Receive courtesy and prompt treatment.
Receive cultural assistance, including having an interpreter during appointments and procedures.
Receive information about us, rights and responsibilities, their benefit plan and which services are not covered.
Know the qualifications of their health care provider.
Give their consent for treatment unless unable to do so because life or health is in immediate danger.
Discuss all treatment options with you without interference from us.
Refuse treatment through an advance directive or withhold treatment consent.
Be free from any restraint used as discipline, retaliation, convenience or force them to do something they do not want to do.
Receive medically necessary services covered by their benefit plan.
Receive information about in-network care providers and practitioners and choose a care provider from our network.
Change care providers at any time for any reason.
Tell us if they are not satisfied with their treatment or with us; they can expect a prompt response.
Tell us their opinions and concerns about services and care received.
Register grievances or complaints concerning the health plan or the care provided.
Appeal any payment or benefit decision we make.
Review the medical records you keep and request changes and/or additions to any area they feel is needed.
Receive information about their condition, understand treatment options, regardless of cost or whether such services are covered, and talk with you when making decisions about their care.
Get a second opinion with an in-network care provider.
Expect health care professionals are not kept from advising them about health status, medical care or treatment, regardless of benefit coverage.
Make suggestions about our member rights and responsibilities policies.
Get more information upon request, such as on how our health plan works and a care provider’s incentive plan, if they apply.
Patient Centered Medical Home
The information will be available during the 4Q203.
Submit a Pre-Service Appeal and or Grievance for a Medicaid Member