We’re working to support care providers and patients during this challenging time. Below are resources and updates to help with ongoing patient care, along with changes to UnitedHealthcare programs and protocols as a result of the national public health emergency. Please check back often for the latest information.
Cost Share Updates for Medicare Advantage
Primary Care Office-Based Professional Services and Primary Care Telehealth
From Oct. 1, 2020 through Dec. 31, 2020, UnitedHealthcare is waiving cost share (copays, coinsurance and deductibles) for all UnitedHealthcare Medicare Advantage plan members for primary care office-based professional services and primary care telehealth services. This includes services rendered by a primary care physician, nurse practitioner or physician assistant in a primary care office. This waiver applies to in-network and covered out-of-network services rendered between Oct. 1, 2020 and Dec. 31, 2020. Starting Oct. 1, 2020, cost sharing for other plan services will be applied in accordance with the member’s benefit plan.
Office Based Professional Services and Telehealth
From May 11, 2020 through Sept. 30, 2020, UnitedHealthcare waived cost share (copays, coinsurance and deductibles) for all UnitedHealthcare Medicare Advantage plan members for office-based professional services and telehealth services performed by both primary care physicians and specialists in the following categories:
Primary care physician office visits
Specialist physician office visits
Physician assistant or nurse practitioner office visits
Chiropractic and acupuncture services (Medicare-covered)
Eye exams, hearing exams and podiatry visits (Medicare-covered or additional covered benefits)
Physical therapy, occupational therapy and speech therapy in an office or outpatient setting
Cardiac and pulmonary rehabilitation services in an office or outpatient hospital setting
Outpatient mental health and substance abuse visits in an office or outpatient setting
Opioid treatment services in an office, outpatient hospital or opioid treatment center setting
This waiver applied to in-network and out-of-network services rendered between May 11, 2020 and Sept. 30, 2020.
Cost sharing for the following place of service categories, provided during the primary care office visits, will not be waived and will apply per the member’s benefit plan:
Inpatient services, outpatient surgery and observation
Skilled nursing services
Home health services
Lab and diagnostic tests (radiological and non-radiological)
Part B drugs, including chemotherapy
Part D drugs
Durable medical equipment (DME)/prosthetics/supplies
ACEI and ARB Medication Prescribing During the COVID-19 National Public Health Emergency Period
Clinicians should not discontinue Angiotensin Converting Enzyme Inhibitor (ACEI) and Angiotensin Receptor Blocker (ARB) medications for their patients with cardiovascular disease based solely on concerns related to COVID-19, as stated in evidence-based medicine protocols for members with cardiovascular disease.
Background and Cardiology Association Recommendations
Based on speculation that ACEI and ARB medications might worsen COVID-19 infectivity and outcomes, some public editorials have suggested that clinicians consider stopping the drugs during the COVID-19 national public health emergency period. Published case series, however, don’t provide evidence that supports such action at this time and there are no definitive clinical studies published on the issue at this time.
The European Society of Cardiology (ESC) Council on Hypertension has issued a statement that says, “The Council on Hypertensionstrongly recommends that physicians and patients should continue treatment with their usual anti-hypertensive therapy, because there is no clinical or scientific evidence to suggest that treatment with ACEI or ARBs should be discontinued because of the COVID-19 infection.”
The Heart Failure Society of America (HFSA), American College of Cardiology (ACC) and American Heart Association (AHA) said in a similar statement that they “recommend continuation of RAAS (Renin Angiotensin Aldosterone System) antagonists for those patients who are currently prescribed such agents for indications for which these agents are known to be beneficial, such as heart failure, hypertension or ischemic heart disease.”
COVID-19 Discharge Planning Resources
If you need assistance with COVID-19 discharge planning, please email UnitedHealthcare at email@example.com. Your questions will be handled by a special team focused on COVID-19 discharge matters. During the national public health emergency period, we will generally respond to requests within two hours, from 8 a.m. to 8 p.m. Eastern Time. Team members are available to assist you seven days a week.
Things to keep in mind when you send your discharge planning questions
Please keep these tips in mind to help us coordinate our response to you and so we can respond to you efficiently and completely:
Format your email subject line in the following way: [Facility/Institution Name; City, State]
Include the following information in your email message:
The name of your facility/institution
The contact name of the person sending the email
The contact information (phone and email) of the person sending the email.
The name, date of birth and insurance policy number of the member you are inquiring about
A brief description of the assistance you need from us
As with all communications involving sensitive member information, please be sure to send your message to us in a secure manner.
Please note that we can also assist with discharge planning for all patients during this time, even if unrelated to COVID-19. You can email us at the address above if you have discharge planning questions unrelated to COVID-19.
Diabetes and Asthma Medication Coverage Changes – Delayed Implementation
The following information applies to commercial pharmacy benefit plans.
Previously, we announced planned changes to coverage for some medications. However, toallow additional time for you and your patients to discuss alternative therapies when appropriate, we’re extending the effective date of coverage changes for some medications from May 1, 2020, to July 1, 2020.This means the following exclusions will now take effect on July 1, 2020:
Diabetes – Insulin: Basaglar® KwikPen®, Levemir®, Levemir® FlexTouch® and Tresiba®
These insulins are currently excluded and will be added to coverage on July 1, 2020: Lantus®, Lantus® SoloSTAR®, Toujeo® Max SoloSTAR® and Toujeo® SoloSTAR®
Diabetes – Non-Insulin: Janumet®, Janumet® XR and Januvia®
Neuromuscular Disorders: Firdapse®
In addition, step therapy for Zomig® will be required effective July 1, 2020 instead of May 1, 2020.
Additionally, we won’t be excluding the following asthma/respiratory medications at this time. These will still be covered medications until further notice: Arnuity Ellipta®, Flovent® Diskus®, Flovent® HFA and Pulmicort Flexhaler®
Since multiple prescription drug lists and benefit variations may occur, you should refer to patient-specific information received through e-prescribing or our PreCheck MyScript® tool on UnitedHealthcare Provider Portal. To learn more about PreCheck MyScript, go to UHCprovider.com/pcms.
ePrescribing for Controlled Substances Policy on Hold
Effective April 10, 2020, OptumRx home delivery pharmacy is placing its mandatory ePrescribing policy for controlled substances (EPCS) temporarily on hold until further notice. This policy went into effect on March 1, 2020 and required care providers to send e-prescriptions for controlled substances.
During the COVID-19 national public health emergency period, OptumRx home delivery pharmacy will fill any controlled substance prescription they receive, as long as the prescription meets federal and state regulatory requirements.
Any care provider or member exemption will remain on file for a year from the date it was submitted.
We’ll share updates as soon as OptumRx home delivery pharmacy determines when the EPCS requirement will resume.
Federally Qualified Health Centers and Rural Health Clinics – Expanded Flexibilities
During the national public health emergency period, the Centers for Medicare & Medicaid Services (CMS) is allowing Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to provide and bill for visiting nursing services by a registered nurse (RN) or licensed practical Nurse (LPN) to homebound individuals in designated home health agency shortage areas. No request for this determination is required.
This applies to all UnitedHealthcare Medicare Advantage benefit plan members, including DSNP members, who are:
Homebound in a designated home health agency shortage area that is in the area typically served by the RHC or in the area included in the FQHC service area plan
Following a written plan of care established and reviewed by a physician every 60 days
Receiving services from an RN or LPN engaged by the RHC or FQHC
Not already receiving home health services
Claims and Billing
FQHCs or RHCs should bill for visiting nursing services according to their normal billing requirements and will be reimbursed according to their designated reimbursement methodology. FQHCs and RHCs can bill for professional-related claims and will be reimbursed separately based on a professional fee schedule.
HouseCalls and Optum At Home
Out of an abundance of caution, we paused HouseCalls and Optum At Home in-person visits with our members on March 20, 2020. This did not apply to services provided somewhere other than in private homes, such as telephone services and treating patients in skilled nursing facilities.
Effective May 22, we resumed in-person visits in some markets. We’re continuing virtual visits in other markets and we will continue to evaluate and resume in-person visits where possible.
Pharmacy 90-Day Refills
Members who have UnitedHealthcare prescription coverage or an Optum Rx pharmacy benefit can get an early prescription refill by calling the pharmacy number on their health plan ID card or speaking directly to a pharmacist. This early refill option is available through at least July 15, 2020. UnitedHealthcare is committed to ensuring members have the medications they need.
Members can also opt to have prescriptions delivered to their home through Optum Home Delivery. They can set up this option online by signing into their health plan account.
Note that certain states have specific requirements related to COVID-19 that may vary. For questions related to specific Medicaid plans, please contact that plan’s Pharmacy Account Manager. Pharmacists or health care professionals who have questions about early prescription refill coverage should call the number on the member’s health plan ID card.
Referral Updates and Reminders
The following information applies to all Medicare Advantage plans. As a result of the COVID-19 national public health emergency period, beginning March 1, 2020:
For Medicare Advantage plans that require referrals to be entered into the UnitedHealthcare Provider Portal, we are not enforcing that requirement through Dec. 31, 2021, or the end of the COVID-19 national public health emergency period, whichever is later.
As of Aug. 1, 2022, coverage for out-of-network services treatment is adjudicated in accordance with the member’s health plan.
Individual and Group Market Health Plans
The following information applies to all Individual and Group Market health plans.
Consistent with existing policy, members do not need a referral for emergency care.
All other standard referral requirements continue to apply.
If a patient is unable to contact their primary care provider (PCP), they can contact Member Services for assistance with a referral. The number for Member Services can be found on their health plan ID card.
The following information applies to Medicaid plans.
Consistent with existing policy, members do not need a referral for emergency care.
The latest advisories, updates and process changes from state health plans can be found on the UnitedHealthcare Community Plan pages, where you’ll also find links to each state’s resources. Note that Florida, Maryland and Rhode Island have state requirements for referrals.
Any COVID-19-related changes that apply at a national level will be outlined on this site as new information becomes available.
The benefits and processes described on this website apply pursuant to federal requirements and UnitedHealthcare national policy during the national emergency. Additional benefits or limitations may apply in some states and under some plans during this time.
We will adjudicate benefits in accordance with the member’s health plan.
Medicaid Providers: UnitedHealthcare will reimburse out-of-network providers for COVID-19 testing-related visits and COVID-19 related treatment or services according to the rates outlined in the Medicaid Fee Schedule.