Important Changes to Insurance Participation

Important Changes to Insurance Participation

Note:This announcement has been updated with changes to the fees expected at time the time of service.

After many years of participation with United Healthcare (also referenced as "UnitedHealthCare" and "UHC") and plans administered by their affiliates, MultiPlan and PHCS, we have decided to end our relationship with United Health Care (and said affiliates) and will no longer be considered participating [in-network] providers. We anticipate that this will become effective January 31, 2023, pending official notification from United Healthcare.

What This Means

If you are faced with changes to your insurance due to your employer, employment status, or during the Open Enrollment period, please consider that, if covered under United Health Care after 31 January 2023, continued care with our office will be considered out-of-network. This may result in our services being covered at a higher cost to you or provide no benefit-coverage at all, depending on the type of UHC plan in which you are enrolled.

Who This Impacts

Many of our patients who are Alabama state retirees are insured through an United Health Care Group Medicare Advantage (PPO) plan. Other patients may have UHC coverage through their employers or purchase UHC coverage through the HealthCare Marketplace. Each of these plans may offer different coverage benefits. Therefore, it is important for patients covered by these plans to verify plan requirements and coverage with UHC, either through UHC's website or by phone at 877-842-3210, to better understand what UHC will pay when receiving services from our office.

Additionally, please note the changes in our filing/payment arrangement for existing patients below.

Further Information

Different Types of Healthcare Plans and Potential Impact

Please look at your current insurance card and see what type of plan you have and how this will affect your coverage with our practice from the following options:

  • UnitedHealthcare Medicare Advantage Plans: If you have a UnitedHealthcare Medicare Advantage plan, you may have network restrictions that affect what doctors, hospitals, and other providers you can see for covered care.
    • Network restrictions depend on which type of Medicare Advantage plan you have.
  • Preferred Provider Organization (PPO)  -- PEEHIP, SEIB fall under this category: A UnitedHealthcare Medicare PPO plan also includes a local network of providers, but beneficiaries may also receive care from providers outside of the network.
    • Any covered care you receive outside of your plan network may come with higher out-of-pocket costs.
  • Health Maintenance Organization (HMO): A UnitedHealthcare Medicare or commercial HMO plan features a localized network of providers. You are typically required to seek medical care from an in-network provider, except for urgent care, emergency room care, and renal dialysis that is out-of-network.
    • Our services are no longer covered once out of network.

For Alabama State Retirees

It is our understanding that patients with a Medicare Advantage (PPO) plan through UHC can continue their care with our practice, since we are Medicare Providers. However, we strongly suggest that our patients verify this with UHC (either through UHC's website or by phone at 877-842-3210).

The following is an excerpt from information that UHC provides to explain the potential impact of coverage changes as they relate to retirees insured through the SEIB UnitedHealthcare® Group Medicare Advantage (PPO) plan, effective in 2020:

Plan Description: ...“Medicare Advantage” is also known as Medical + Part D health insurance. These plans have all the benefits of Medicare Part A (hospital coverage), Medicare Part B (doctor and outpatient care), Medicare Part D (Prescription coverage) plus extra program that go beyond Original Medicare (Medicare Parts A and B).

Q: What if my doctor does not have a contract with UHC?
A: The UnitedHealthcare® Group Medicare Advantage (PPO) plan does not require a doctor to have a contract with UnitedHealthcare. Under this plan, doctors without a contract will be paid the same reimbursement as they receive from Medicare. Most doctors accept this type of plan once they understand they do not need a contract and they will be paid the same as Medicare. Beginning in September, you will be able to contact UnitedHealthcare with any questions regarding your new plan. UnitedHealthcare will communicate with providers in Alabama to explain how the plan works and, if necessary, UnitedHealthcare and SEIB will encourage your doctor or health care facility to
continue seeing you.

Q: What is the difference between in-network and out-of-network providers?
A: In-network providers have a contract with UnitedHealthcare. Out-of-network providers do not have a contract. With this plan, you have the flexibility to see any provider (in-network or out-of-network) at the same cost share, as long as they accept the plan and have not opted out of or been excluded from Medicare. Also, when you go out-of-network for care, the plan pays providers just as much as Medicare would have paid. In Alabama, there are over 1,400 in-network providers and over 100 in-network hospitals across the state.

For all other patients covered through UHC

Please review UHC's Out of Network flyer for more information on out-of-network benefits.

UPDATE/Additional Comments

We understand that this is a hardship for many of our patients. We hope that we have provided you with ample time and the resources to navigate this change. If you are continuing your care with our practice and your insurance carrier is United Healthcare or administered by United Healthcare, these are the changes you can expect:

  • Effective February 1, 2023:
    • You will be required to pay the total charges of your visit at the time of service (not just a co-payment, co-insurance or allowed amount)
    • We will file your claims as a courtesy
    • Your insurance carrier may or may not reimburse you based on your policy coverage
    • Any claim resubmission or disputes will be handled by the patient
    • This relates to both Commercial and Medicare Advantage Plans