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Out-of-Network Outpatient Benefit Update

Effective July 1, 2020, certain UnitedHealthcare commercial members will no longer have benefits for out-of-network Laboratory, Dialysis and Durable Medical Equipment (DME) services.

UnitedHealthcare requires physicians and other qualified health care professionals to inform our members when involving an out-of-network providers in the member’s care for non-emergent services. 

If you do not obtain the member’s consent for an out-of-network referral for non-emergent services, you will be in violation of your agreement.  As a result, we may, depending on state law:

  • Disqualify you from any rewards or incentive program
  • Decrease your fee schedule
  • Hold you financially responsible for any costs collected from a member by a non-participating care provider
  • Terminate your Agreement
  • Disqualify the provider from any rewards or incentive program

Resources

Consent Form:  Member Consent for Referring Out-of-Network Form

Provider Protocol Requirements: UHCprovider.com > Chapter 5: Referrals > Non-Participating Care Providers (All Commercial Plans)

How do I find a network provider?

You can visit myuhc.com or UHCprovider.com to search for providers near you. You can also call us at the toll-free member phone number on the member’s health plan ID card.