The Benefit Interpretation Policies and corresponding update bulletins for UnitedHealthcare West are listed below.
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A monthly notice of recently approved and/or revised Benefit Interpretation Policies (BIPs) is provided below for your review. We publish a new announcement on the first calendar day of every month.
The appearance of a health service (e.g., test, drug, device or procedure) in the Benefit Interpretation Policy Update Bulletin does not imply that UnitedHealthcare provides coverage for the health service. In the event of an inconsistency or conflict between the information provided in the Benefit Interpretation Policy Update Bulletin and the posted policy, the provisions of the posted policy will prevail.
01/01/2020 – UnitedHealthcare West Benefit Interpretation Policy Update Bulletin: January 2020
Last Published 01.01.2020
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare West Benefit Interpretation Policies.
02/01/2020 – UnitedHealthcare West Benefit Interpretation Policy Update Bulletin: February 2020
Last Published 02.01.2020
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare West Benefit Interpretation Policies.
03/01/2020 – UnitedHealthcare West Benefit Interpretation Policy Update Bulletin: March 2020
Last Published 03.01.2020
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare West Benefit Interpretation Policies.
UnitedHealthcare West Benefit Interpretation Policy Update Bulletin Archive
Last Published 03.01.2020
Current Benefit Interpretation Policies
UnitedHealthcare West Benefit Interpretation Policies
Please read the terms and conditions below carefully.
UnitedHealthcare has developed Benefit Interpretation Policies to assist us in administering health benefits. These policies are provided for informational purposes, and do not constitute medical advice. Treating physicians and health care providers are solely responsible for determining what care to provide to their patients. Members should always consult their physician before making any decisions about medical care.
Benefit coverage for health services is determined by the member specific benefit plan document, such as an Evidence of Coverage or Schedule of Benefits, the Employer's Group Subscriber Agreement, and applicable laws that may require coverage for a specific service. The member specific benefit plan document identifies which services are covered, which are excluded, and which are subject to limitations. In the event of a conflict, the member specific benefit plan document supersedes these policies.
Our Benefit Interpretation Policies are based upon: (1) federal and/or state laws and regulations which may be applicable to UnitedHealthcare® West; and (2) research, studies, and evidence from other sources (including, but not limited to, the Food and Drug Administration). Benefit Interpretation Policies assist healthcare providers in making coverage determinations, but do not replace an individualized case-by- case review and medical necessity determination for each UnitedHealthcare® West member. All services rendered must be medically necessary as determined by the member's provider. All services rendered must be referred and authorized by the member's provider (unless specifically stated in the member specific benefit plan documents).
Benefit Interpretation Policies are developed as needed, are regularly reviewed and updated, and are subject to change. They represent a portion of the resources used to support UnitedHealthcare coverage decision making. The information presented in these policies is believed to be accurate and current as of the date of publication, and is provided on an "AS IS" basis.
Benefit Interpretation Policies are the property of UnitedHealthcare. Unauthorized copying, use and distribution of this information are strictly prohibited. Health Plan coverage is provided by or through UnitedHealthcare of California, UnitedHealthcare Benefits Plan of California, UnitedHealthcare of Oklahoma, Inc., UnitedHealthcare of Oregon, Inc., UnitedHealthcare Benefits of Texas, Inc., and UnitedHealthcare of Washington, Inc.
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Abortions: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 11.01.2019
Effective 11.01.2019 – This policy addresses termination of pregnancy, spontaneous abortions, and selective fetal reductions.
Abortions: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 11.01.2019
Effective 11.01.2019 – This policy addresses termination of pregnancy, spontaneous abortions, and selective fetal reductions.
Acquired Brain Injury Services: TX – UnitedHealthcare West Benefit Interpretation Policy
Last Published 07.01.2019
Effective 07.01.2019 – This policy addresses inpatient and outpatient acquired brain injury rehabilitation services, in-home acquired brain injury care, biofeedback, cognitive behavior therapy, coma stimulations, and cognitive rehabilitation under custodial care.
Allergy Testing and Injections: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 02.01.2020 – This policy addresses allergy testing, treatment, and supplies, including allergy serum injections.
Allergy Testing and Injections: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.01.2020
Effective 02.01.2020 – This policy addresses allergy testing, treatment, and supplies, including allergy serum injections.
Ambulance Transportation: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 01.01.2020 – This policy addresses ambulance transportation by ground or air.
Ambulance Transportation: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 09.01.2019
Effective 09.01.2019 – This policy addresses ambulance transportation by ground or air.
Attention Deficit Hyperactivity Disorder (ADHD): CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 08.01.2019
Effective 08.01.2019 – This policy addresses attention deficit hyperactivity disorder (ADHD) medical management, consultation and evaluation services, treatment of underlying coexistent medical conditions, behavior modification, and family counseling.
Attention Deficit Hyperactivity Disorder (ADHD): OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 08.01.2019
Effective 08.01.2019 – This policy addresses attention deficit hyperactivity disorder (ADHD) medical management, consultation and evaluation services, treatment of underlying coexistent medical conditions, behavior modification, and family counseling.
Biofeedback: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 10.01.2019
Effective 10.01.2019 – This policy addresses biofeedback for bladder rehabilitation.
Biofeedback: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 10.01.2019
Effective 10.01.2019 – This policy addresses biofeedback for bladder rehabilitation, migraine headaches, and acquired brain injury.
Blood and Blood Products: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 08.01.2019
Effective 08.01.2019 – This policy addresses blood and blood products, blood clotting factors, and blood-associated costs.
Blood and Blood Products: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 08.01.2019
Effective 08.01.2019 – This policy addresses blood and blood products, blood clotting factors, and blood-associated costs.
Cardiac Pacemakers and Defibrillators: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 04.01.2019 – This policy addresses cardiac pacemakers, cardiac pacemaker monitoring, implantable automatic defibrillators, and automatic external defibrillators.
Cardiac Pacemakers and Defibrillators: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 04.01.2019 – This policy addresses cardiac pacemakers, cardiac pacemaker monitoring, implantable automatic defibrillators, and automatic external defibrillators.
Cardiac Rehabilitation Services - Outpatient: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 04.01.2019 – This policy addresses outpatient cardiac rehabilitation services.
Cardiac Rehabilitation Services - Outpatient: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 04.01.2019 – This policy addresses outpatient cardiac rehabilitation services.
Chemical Dependency/Substance Abuse Detoxification: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 07.01.2019
Effective 07.01.2019 – This policy addresses inpatient and outpatient chemical dependency/substance abuse detoxification services and methadone maintenance.
Chemical Dependency/Substance Abuse Detoxification: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 07.01.2019
Effective 07.01.2019 – This policy addresses inpatient and outpatient chemical dependency/substance abuse detoxification services and methadone maintenance.
Chemical Dependency/Substance Abuse Rehabilitation: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 08.01.2019
Effective 08.01.2019 – This policy addresses chemical dependency/substance abuse rehabilitation.
Chemical Dependency/Substance Abuse Rehabilitation: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 01.01.2020 – This policy addresses chemical dependency/substance abuse rehabilitation.
Chemotherapy: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 12.01.2019 – This policy addresses chemotherapy, immunotherapy, and hormonal agents, injectable drugs, infusion therapy, oral drugs, and related oncology services.
Chemotherapy: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 12.01.2019 – This policy addresses chemotherapy, immunotherapy, and hormonal agents, injectable drugs, infusion therapy, oral drugs, and related oncology services.
Clinical Trials: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 11.01.2019
Effective 11.01.2019 – This policy addresses state mandates pertaining to clinical trials.
Clinical Trials: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 11.01.2019
Effective 11.01.2019 – This policy addresses state mandates pertaining to clinical trials.
Cognitive Rehabilitation: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 07.01.2019
Effective 07.01.2019 – This policy addresses outpatient and inpatient cognitive rehabilitation therapy and habilitative services.
Cognitive Rehabilitation: OK – UnitedHealthcare West Benefit Interpretation Policy
Last Published 07.01.2019
Effective 07.01.2019 – This policy addresses outpatient and inpatient cognitive rehabilitation therapy.
Cognitive Rehabilitation: OR – UnitedHealthcare West Benefit Interpretation Policy
Last Published 07.01.2019
Effective 07.01.2019 – This policy addresses outpatient and inpatient cognitive rehabilitation therapy and habilitative services.
Cognitive Rehabilitation: TX – UnitedHealthcare West Benefit Interpretation Policy
Last Published 07.01.2019
Effective 07.01.2019 – This policy refers to the Acquired Brain Injury Services Benefit Interpretation Policy for applicable coverage guidelines for cognitive rehabilitation.
Cognitive Rehabilitation: WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 07.01.2019
Effective 07.01.2019 – This policy addresses outpatient and inpatient cognitive rehabilitation therapy and habilitative services.
Complementary and Alternative Medicine: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.01.2020
Effective 02.01.2020 – This policy addresses complementary and alternative medicine, including acupuncture, chiropractic care, and massage therapy.
Complementary and Alternative Medicine: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.01.2020
Effective 02.01.2020 – This policy addresses complementary and alternative medicine, including acupuncture, acupressure, chiropractic care, massage therapy, and neuropath.
Continuity of Care: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 11.01.2019
Effective 11.01.2019 – This policy addresses continuity of care conditions and continuing care with a terminated provider for members.
Continuity of Care: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 11.01.2019
Effective 11.01.2019 – This policy addresses continuity of care and continuing care with a terminated provider for members.
Cosmetic, Reconstructive, or Plastic Surgery: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.01.2020
Effective 02.01.2020 – This policy addresses cosmetic, reconstructive, and plastic surgical procedures.
Cosmetic, Reconstructive, or Plastic Surgery: OK – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.01.2020
Effective 02.01.2020 – This policy addresses cosmetic, reconstructive, and plastic surgical procedures.
Cosmetic, Reconstructive, or Plastic Surgery: OR – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.01.2020
Effective 02.01.2020 – This policy addresses cosmetic, reconstructive, and plastic surgical procedures.
Cosmetic, Reconstructive, or Plastic Surgery: TX – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.01.2020
Effective 02.01.2020 – This policy addresses cosmetic, reconstructive, and plastic surgical procedures.
Cosmetic, Reconstructive, or Plastic Surgery: WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.01.2020
Effective 02.01.2020 – This policy addresses cosmetic, reconstructive, and plastic surgical procedures.
Court, Attorney, or Agency Requested Services: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.01.2020
Effective 02.01.2020 – This policy addresses court, attorney, or agency requested services, including emergency and urgently needed servces.
Court, Attorney, or Agency Requested Services: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.01.2020
Effective 02.01.2020 – This policy addresses court, attorney, or agency requested services, including emergency and urgently needed servces.
Dental Care and Oral Surgery: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 12.01.2019 – This policy addresses dental care services and oral surgery.
Dental Care and Oral Surgery: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 12.01.2019 – This policy addresses dental care services and oral surgery.
Developmental Delay and Learning Disabilities: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 09.01.2019
Effective 09.01.2019 – This policy addresses services for the treatment of developmental delay and learning disabilities. This policy applies to members with diagnosed or suspected developmental delay, either global or limited to a specific developmental area.
Developmental Delay and Learning Disabilities: OK – UnitedHealthcare West Benefit Interpretation Policy
Last Published 09.01.2019
Effective 09.01.2019 – This policy addresses services for the treatment of developmental delay and learning disabilities. This policy applies to members with diagnosed or suspected developmental delay, either global or limited to a specific developmental area.
Developmental Delay and Learning Disabilities: OR – UnitedHealthcare West Benefit Interpretation Policy
Last Published 09.01.2019
Effective 09.01.2019 – This policy addresses services for the treatment of developmental delay and learning disabilities. This policy applies to members with diagnosed or suspected developmental delay, either global or limited to a specific developmental area.
Developmental Delay and Learning Disabilities: TX – UnitedHealthcare West Benefit Interpretation Policy
Last Published 09.01.2019
Effective 09.01.2019 – This policy addresses services for the treatment of developmental delay and learning disabilities. This policy applies to members with diagnosed or suspected developmental delay, either global or limited to a specific developmental area.
Developmental Delay and Learning Disabilities: WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 09.01.2019
Effective 09.01.2019 – This policy addresses services for the treatment of developmental delay and learning disabilities. This policy applies to members with diagnosed or suspected developmental delay, either global or limited to a specific developmental area.
Diabetic Management, Services and Supplies: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 03.01.2020
Effective 03.01.2020 – This policy addresses diabetic management and treatment, including outpatient diabetic self-management training, diabetic supplies and equipment, continuous subcutaneous insulin infusion pump (CSII) and related supplies, visual aids, pen delivery systems, test strips, diabetic tablets, and insulin syringes.
Diabetic Management, Services and Supplies: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 03.01.2020
Effective 03.01.2020 – This policy addresses diabetic management and treatment, including outpatient diabetic self-management training, diabetic supplies and equipment, continuous subcutaneous insulin infusion pump (CSII) and related supplies, visual aids, pen delivery systems, test strips, diabetic tablets, and insulin syringes.
Diagnostic and Therapeutic Radiology Services: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 12.01.2019 – This policy addresses inpatient and outpatient diagnostic and therapeutic radiological services, including standard X-rays and specialized scanning, imaging and other specialized procedures.
Diagnostic and Therapeutic Radiology Services: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 12.01.2019 – This policy addresses inpatient and outpatient diagnostic and therapeutic radiological services, including standard X-rays and specialized scanning, imaging and other specialized procedures.
Dialysis Services: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.01.2020
Effective 02.01.2020 – This policy addresses acute and chronic dialysis (peritoneal or hemodialysis) services and supplies.
Dialysis Services: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.01.2020
Effective 02.01.2020 – This policy addresses acute/sudden and chronic long term dialysis (peritoneal or hemodialysis) services.
Durable Medical Equipment (DME), Prosthetics, Corrective Appliances/Orthotics (Non-Foot Orthotics) and Medical Supplies Grid: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.01.2020
Effective 02.01.2020 – This policy addresses specific durable medical equipment (DME), prosthetics, corrective appliances/orthotics (non-foot orthotics), and medical supplies.
Durable Medical Equipment (DME), Prosthetics, Corrective Appliances/Orthotics (Non-Foot Orthotics) and Medical Supplies Grid: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.01.2020
Effective 02.01.2020 – This policy addresses specific durable medical equipment (DME), prosthetics, corrective appliances/orthotics (non-foot orthotics), and medical supplies.
Durable Medical Equipment (DME), Prosthetics, Corrective Appliances/Orthotics (Non-Foot Orthotics) and Medical Supplies: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.01.2020
Effective 02.01.2020 – This policy addresses durable medical equipment (DME), prosthetics, corrective appliances/orthotics (non-foot orthotics), and medical supplies.
Durable Medical Equipment (DME), Prosthetics, Corrective Appliances/Orthotics (Non-Foot Orthotics) and Medical Supplies: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.01.2020
Effective 02.01.2020 – This policy addresses durable medical equipment (DME), prosthetics, corrective appliances/orthotics (non-foot orthotics), and medical supplies.
Educational Programs for Members: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 06.01.2019
Effective 06.01.2019 – This policy addresses member education programs, nutritional counseling, and health education services.
Educational Programs for Members: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 06.01.2019
Effective 06.01.2019 – This policy addresses member education programs, nutritional counseling, and health education services.
Emergency and Urgent Services: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 12.01.2019 – This policy addresses emergency services and urgently needed services.
Emergency and Urgent Services: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 12.01.2019 – This policy addresses emergency services and urgently needed services.
Enteral and Oral Nutritional Therapy: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 12.01.2019 – This policy addresses enteral and oral nutritional therapy, including formula, accessories, and supplies.
Enteral and Oral Nutritional Therapy: OK – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 12.01.2019 – This policy addresses enteral and oral nutritional therapy, including formula, accessories, and supplies.
Enteral and Oral Nutritional Therapy: OR – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 12.01.2019 – This policy addresses enteral and oral nutritional therapy, including formula, accessories, and supplies.
Enteral and Oral Nutritional Therapy: TX – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 12.01.2019 – This policy addresses enteral and oral nutritional therapy, including formula, accessories, and supplies.
Enteral and Oral Nutritional Therapy: WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 12.01.2019 – This policy addresses enteral and oral nutritional therapy, including formula, accessories, and supplies.
Experimental and Investigational Services: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 09.01.2019
Effective 09.01.2019 – This policy addresses experimental and/or investigational procedures, items, treatments, studies, tests, drugs, and equipment.
Experimental and Investigational Services: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 09.01.2019
Effective 09.01.2019 – This policy addresses experimental and/or investigational procedures, items, treatments, studies, tests, drugs, and equipment.
Family Planning: Birth Control: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 05.01.2019
Effective 05.01.2019 – This policy addresses birth control and contraception methods.
Family Planning: Birth Control: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 05.01.2019
Effective 05.01.2019 – This policy addresses birth control and contraception methods.
Family Planning: Infertility Services: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 01.01.2020
Effective 01.01.2020 – This policy addresses infertility services.
Family Planning: Infertility Services: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 07.01.2019
Effective 07.01.2019 – This policy addresses infertility services.
Foot Care and Podiatry Services: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 06.01.2019
Effective 06.01.2019 – This policy addresses routine foot care, foot examination, and other podiatry services.
Foot Care and Podiatry Services: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 06.01.2019
Effective 06.01.2019 – This policy addresses routine foot care, foot examination, and other podiatry services.
Gender Dysphoria (Gender Identity Disorder) Treatment: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 11.01.2019
Effective 11.01.2019 – This policy addresses surgical and non-surgical treatment for gender dysphoria.
Gender Dysphoria (Gender Identity Disorder) Treatment: OR – UnitedHealthcare West Benefit Interpretation Policy
Last Published 11.01.2019
Effective 11.01.2019 – This policy addresses gender dysphoria (gender identity disorder) treatment.
Gender Dysphoria (Gender Identity Disorder) Treatment: WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 11.01.2019
Effective 11.01.2019 – This policy addresses gender dysphoria (gender identity disorder) treatment.
Genetic Testing: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 06.01.2019
Effective 05.01.2019 – This policy addresses genetic testing and counseling.
Genetic Testing: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 06.01.2019
Effective 05.01.2019 – This policy addresses genetic testing and counseling.
Habilitative Services: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 01.01.2020
Effective 01.01.2020 – This policy addresses outpatient habilitative services, including physical therapy, occupational therapy, post-cochlear implant aural therapy, cognitive habilitative therapy, manipulative treatment, and speech therapy.
Habilitative Services: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 01.01.2020
Effective 01.01.2020 – This policy addresses outpatient habilitative services, including physical therapy, occupational therapy, post-cochlear implant aural therapy, cognitive habilitative therapy, manipulative treatment, and speech therapy.
Hearing Services: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 09.01.2019
Effective 09.01.2019 – This policy addresses hearing screening services, hearing examinations, audiologist diagnostic testing and evaluation, cochlear implant, and hearing aids.
Hearing Services: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 09.01.2019
Effective 09.01.2019 – This policy addresses hearing screening services, hearing examinations, audiologist diagnostic testing and evaluation, cochlear implant, and hearing aids.
Home Health Care: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 11.01.2019
Effective 11.01.2019 – This policy addresses home health care visits and related services.
Home Health Care: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 11.01.2019
Effective 11.01.2019 – This policy addresses home health care visits and related services.
Hospice: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 10.01.2019
Effective 10.01.2019 – This policy addresses hospice and respite care.
Hospice: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 10.01.2019
Effective 10.01.2019 – This policy addresses hospice and respite care.
Immunizations/Vaccinations: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 10.01.2019
Effective 10.01.2019 – This policy addresses vaccinations/immunizations.
Immunizations/Vaccinations: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 10.01.2019
Effective 10.01.2019 – This policy addresses vaccinations/immunizations.
Inpatient and Outpatient Mental Health: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 12.01.2019 – This policy addresses inpatient and outpatient mental health services.
Inpatient and Outpatient Mental Health: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 12.01.2019 – This policy addresses inpatient and outpatient mental health services.
Inpatient Hospital Services: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 10.01.2019
Effective 10.01.2019 – This policy addresses acute inpatient hospital services and supplies.
Inpatient Hospital Services: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 10.01.2019
Effective 10.01.2019 – This policy addresses acute inpatient hospital services and supplies.
Maternity and Newborn Care: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.01.2020
Effective 02.01.2020 – This policy addresses prenatal and postnatal care, inpatient maternity care, and newborn care.
Maternity and Newborn Care: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.01.2020
Effective 02.01.2020 – This policy addresses prenatal and postnatal care, inpatient maternity care, and newborn care.
Medical Necessity: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 01.01.2020 – This policy addresses medically necessary interventions.
Medical Necessity: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 01.01.2020
Effective 01.01.2020 – This policy addresses medically necessary interventions.
Medications and Off-Label Drugs: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 01.01.2020
Effective 01.01.2020 – This policy addresses injectable drugs, off-label drug use, tobacco cessation medications, and outpatient drugs and prescription medications.
Medications and Off-Label Drugs: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 08.01.2019
Effective 08.01.2019 – This policy addresses injectable drugs, off-label drug use, tobacco cessation programs/medications, human growth hormone, and outpatient drugs and prescription medications.
Member Initiated Second and Third Opinion: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 01.01.2020
Effective 01.01.2020 – This policy addresses member-initiated second and third medical opinions.
Member Initiated Second and Third Opinion: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 01.01.2020
Effective 01.01.2020 – This policy addresses member-initiated second and third medical opinions.
Outpatient Hospital Services: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 10.01.2019
Effective 10.01.2019 – This policy addresses outpatient hospital services.
Outpatient Hospital Services: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 10.01.2019
Effective 10.01.2019 – This policy addresses outpatient hospital services.
Pain Management: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 01.01.2020 – This policy addresses pain management for long term and acute pain.
Pain Management: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 01.01.2020
Effective 01.01.2020 – This policy addresses pain management for long term and sudden pain.
Parenteral Nutrition Therapy: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 12.01.2019 – This policy addresses parenteral nutrition therapy.
Parenteral Nutrition Therapy: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 12.01.2019– This policy addresses parenteral nutrition therapy.
Pervasive Developmental Disorder and Autism Spectrum Disorder: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 01.01.2020
Effective 01.01.2020 – This policy addresses behavioral health treatment for pervasive developmental disorder (PDD) or autism spectrum disorder.
Pervasive Developmental Disorder and Autism Spectrum Disorder: OK – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 01.01.2020 – This policy addresses pervasive developmental disorders and autism spectrum disorder, including assessment, testing, coordination of care, referral for consultation/evaluation, therapies, treatment programs, and prescription drugs.
Pervasive Developmental Disorder and Autism Spectrum Disorder: OR – UnitedHealthcare West Benefit Interpretation Policy
Last Published 01.01.2020
Effective 01.01.2020 – This policy addresses pervasive developmental disorders and autism spectrum disorder, including assessment, coordination of care, referral for consultation/evaluation, medical services, speech/occupational/physical therapy, and therapies, educational services, and behavioral services for autism spectrum disorder.
Pervasive Developmental Disorder and Autism Spectrum Disorder: TX – UnitedHealthcare West Benefit Interpretation Policy
Last Published 01.01.2020
Effective 01.01.2020 – This policy addresses pervasive developmental disorders and autism spectrum disorder, including assessment, coordination of care, applied behavioral analysis, behavior training/management/modification, speech/occupational/physical therapy, medications/supplements, and routine laboratory testing.
Pervasive Developmental Disorder and Autism Spectrum Disorder: WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 01.01.2020
Effective 01.01.2020 – This policy addresses pervasive developmental disorders and autism spectrum disorder, including assessment, coordination of care, referral for consultation/evaluation, medically necessary neuro-developmental therapies, speech/occupational/physical therapy, and applied behavioral analysis.
Physician Services: Primary Care and Specialist Visits: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 06.01.2019
Effective 06.01.2019 – This policy addresses physician care (primary care physician, provider and specialist) diagnostic, consultation, and treatment services and referred specialist services.
Physician Services: Primary Care and Specialist Visits: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 06.01.2019
Effective 06.01.2019 – This policy addresses physician care (primary care physician, provider and specialist) diagnostic, consultation, and treatment services and referred specialist services.
Post Mastectomy Surgery: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.01.2020
Effective 02.01.2020 – This policy addresses post mastectomy surgery.
Post Mastectomy Surgery: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.01.2020
Effective 02.01.2020 – This policy addresses post mastectomy surgery.
Preventive Care Services: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 07.01.2019
Effective 07.01.2019 – This policy addresses preventive health care services.
Preventive Care Services: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 01.01.2020 – This policy addresses preventive health care services.
Rehabilitation Services (Physical, Occupational, and Speech Therapy): CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 04.01.2019 – This policy addresses rehabilitation services, including acute inpatient rehabilitation, outpatient physical and occupational therapy, and speech therapy.
Rehabilitation Services (Physical, Occupational, and Speech Therapy): OK – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 04.01.2019 – This policy addresses rehabilitation services, including acute inpatient rehabilitation, outpatient physical and occupational therapy, and speech therapy.
Rehabilitation Services (Physical, Occupational, and Speech Therapy): OR – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 04.01.2019 – This policy addresses rehabilitation services, including acute inpatient rehabilitation, outpatient physical and occupational therapy, and speech therapy.
Rehabilitation Services (Physical, Occupational, and Speech Therapy): TX – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 04.01.2019 – This policy addresses rehabilitation services, including acute inpatient rehabilitation, outpatient physical and occupational therapy, and speech therapy.
Rehabilitation Services (Physical, Occupational, and Speech Therapy): WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 02.11.2020
Effective 04.01.2019 – This policy addresses rehabilitation services, including acute inpatient rehabilitation, outpatient physical and occupational therapy, and speech therapy.
Services While Confined/Incarcerated: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 03.01.2020
Effective 03.01.2020 – This policy addresses services received while confined/incarcerated, or, if a juvenile, while detained in any facility.
Services While Confined/Incarcerated: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 03.01.2020
Effective 03.01.2020 – This policy addresses services received while confined/incarcerated, or, if a juvenile, while detained in any facility.
Services/Complications Related to Non-Covered Services: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 06.01.2019
Effective 06.01.2019 – This policy addresses services or costs associated with a non-covered service.
Services/Complications Related to Non-Covered Services: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 06.01.2019
Effective 06.01.2019 – This policy addresses services or costs associated with a non-covered service.
Sexual Dysfunction: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 09.01.2019
Effective 09.01.2019 – This policy addresses diagnostic services, medications/drugs, procedures, services, and supplies for the treatment of sexual dysfunction or inadequacy.
Sexual Dysfunction: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 09.01.2019
Effective 09.01.2019 – This policy addresses diagnostic services, medications/drugs, procedures, services, and supplies for the treatment of sexual dysfunction or inadequacy.
Shoes and Foot Orthotics: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 06.01.2019
Effective 06.01.2019 – This policy addresses specialized footwear, shoes, and foot orthotics.
Shoes and Foot Orthotics: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 06.01.2019
Effective 06.01.2019 – This policy addresses specialized footwear, shoes, and foot orthotics.
Skilled Nursing Facility (SNF): Skilled Nursing Facility (SNF) Care: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 03.01.2020
Effective 03.01.2020 – This policy addresses skilled nursing facility (SNF) care.
Skilled Nursing Facility (SNF): Skilled Nursing Facility (SNF) Care: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 03.01.2020
Effective 03.01.2020 – This policy addresses skilled nursing facility (SNF) care.
Telemedicine/Telehealth Services/Virtual Visits: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 01.01.2020
Effective 01.01.2020 – This policy addresses telemedicine/telehealth services and virtual visits.
Telemedicine/Telehealth Services/Virtual Visits: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 01.01.2020
Effective 01.01.2020 – This policy addresses telemedicine/telehealth services and virtual visits.
Transplantation Services: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 11.01.2019
Effective 11.01.2019 – This policy addresses human organ and tissue transplants, donor-related services (including organ acquisition), pre-transplant testing and evaluation/examination, bone marrow and stem cell transplants, and transplant related costs and services.
Transplantation Services: OK, OR, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 11.01.2019
Effective 11.01.2019 – This policy addresses human organ and tissue transplants, donor-related services (including organ acquisition), pre-transplant testing and evaluation/examination, bone marrow and stem cell transplants, and transplant related costs and services.
Transplantation Services: TX – UnitedHealthcare West Benefit Interpretation Policy
Last Published 11.01.2019
Effective 11.01.2019 – This policy addresses human organ and tissue transplants, donor-related services (including organ acquisition), pre-transplant testing and evaluation/examination, bone marrow and stem cell transplants, and transplant related costs and services.
Treatment of Extreme Obesity: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 07.01.2019
Effective 07.01.2019 – This policy addresses surgical and non-surgical treatments and related services for extreme obesity.
Treatment of Extreme Obesity: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 07.01.2019
Effective 07.01.2019 – This policy addresses surgical and non-surgical treatments and related services for extreme obesity.
Treatment of Temporomandibular Joint (TMJ) Disorders: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 05.01.2019
Effective 05.01.2019 – This policy addresses treatment for temporomandibular joint (TMJ) disorders.
Treatment of Temporomandibular Joint (TMJ) Disorders: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 05.01.2019
Effective 05.01.2019 – This policy addresses treatment for temporomandibular joint (TMJ) disorders.
Veteran's Administration (VA): CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 06.01.2019
Effective 06.01.2019 – This policy addresses Veteran's Administration (VA) services, including emergency/urgent care services, skilled nursing facility (SNF) care, out-of-area services, and non-emergent services.
Veteran's Administration (VA): OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 06.01.2019
Effective 06.01.2019 – This policy addresses Veteran's Administration (VA) services, including emergency/urgent care services, skilled nursing facility (SNF) care, out-of-area services, and non-emergent services.
Vision Care and Services: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 07.01.2019
Effective 07.01.2019 – This policy addresses vision care and services, including eye exams, eyeglasses, contact lenses, intraocular lenses (IOLs), surgical and laser procedures, and visual aids.
Vision Care and Services: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 07.01.2019
Effective 07.01.2019 – This policy addresses vision care and services, including eye examinations, eyeglasses, contact lenses, intraocular lenses (IOLs), surgical and laser procedures, and visual aids.
Weight Gain or Weight Loss Programs: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 07.01.2019
Effective 07.01.2019 – This policy addresses weight gain and weight loss programs, prescription drugs to treat obesity, and enhancement medications.
Weight Gain or Weight Loss Programs: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 07.01.2019
Effective 07.01.2019 – This policy addresses weight gain and weight loss programs and prescription drugs to treat obesity.
Wheelchairs and Accessories: CA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 06.01.2019
Effective 06.01.2019 – This policy addresses wheelchairs and applicable repairs, replacements, maintenance, accessories, and options.
Wheelchairs and Accessories: OK, OR, TX, WA – UnitedHealthcare West Benefit Interpretation Policy
Last Published 06.01.2019
Effective 06.01.2019 – This policy addresses wheelchairs and applicable repairs, replacements, maintenance, accessories, and options.
For questions, please contact your local Network Management representative or call the Provider Services number on the back of the member’s ID card.