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UnitedHealthcare Community Plan Indiana PathWays for Aging - Member Communications

Welcome to Indiana PathWays for Aging. Below you'll find information we've shared with our members and caregivers. If you have not  received a mailing and would like more details, please call Member Services at 1-800-832-4643, TTY 711. We are open from 8 am to 8 pm EST, Monday - Friday.

Thank you for being a UnitedHealthcare member. This letter is about your Indiana PathWays for Aging program. We support you so that you may live as independently as possible, for as long as possible. Each year, we share valuable information with you.

If you have questions or want more information:

  • Call Member Services at 1-800-832-4643. TTY users may dial 711. We are open 8 am to 8 pm ET, Monday through Friday.
  • Review the Member Handbook. It has more detailed information about your benefits, coverage, and options available to you. The handbook is available online at MyUHC.com/CommunityPlan. You may call Member Services to get a handbook by mail. We can send it to you in large print, braille, or other languages.

Grievances and Appeals
If you have a complaint or problem with the care you are getting, you can file a grievance with us at any time. It can be a written letter, filed online, or a phone call. Your Provider or Member Services can also file a grievance on your behalf.

You may file a grievance over the phone with Member Services at 1-800-832-4643, TTY 711. Our secure member portal, myuhc.com/communityplan, offers an option to file a grievance online. You may also file a written grievance by sending it to:

UnitedHealthcare Grievances and Appeals
P.O. Box 31364
Salt Lake City, UT 84131-0364

If you disagree with any action that denies or delays your care, you can file an appeal. If your provider or member representative has your written permission, they can file an appeal on your behalf. You can also call the Ombudsman for help. You can appeal in writing, online, or over the phone by calling Member Services.

If you file an appeal, you will continue to get any services you were already getting as long as you file within ten (10) days of when our letter was mailed or the date the change would be effective. If the appeal is not decided in your favor, you may have to pay for the services you received during the appeal process.

You may file an appeal over the phone with Member Services at 1-800-832-4643, TTY 711. You may file appeals online at myuhc.com/communityplan. You may also file a written appeal by sending it to:

UnitedHealthcare Grievances and Appeals
P.O. Box 31364
Salt Lake City, UT 84131-0364

If you need your appeal reviewed more quickly, you can request an expedited (rush) appeal and get an answer back from us within forty-eight (48) hours. If your request to rush the appeal will not be reviewed as accepted as expedited, it becomes a standard appeal and will be reviewed within thirty (30) days.

If you have finished your appeal at UnitedHealthcare Community Plan, and you think we made a mistake about your appeal, you, the provider, or other delegated person acting as an approved representative for you may ask for a State Fair Hearing from the Indiana Family and Social Services Administration (FSSA). Also, in the event UnitedHealthcare Community Plan does not respond to you or resolve your appeal or grievance in a timely manner, you may ask for a State Fair Hearing. It must be filed within 120 calendar days of the date on letter. You can request it by mail, fax, or email.

Mail: Office of Administrative Law Proceedings - FSSA Hearings
100 N. Senate Avenue, Room N802
Indianapolis, IN 46204
Phone: 317-234-3488, or toll-free 1-866-259-3573
Fax: 317-232-4412
Email: fssa.appeals@oalp.in.gov

If you file a State Fair Hearing, you will continue to get any services you were already getting as long as you file within ten (10) days of when our Notice of Appeal Resolution letter was mailed or the date the change would be effective.

Getting advice or help
You can call an Ombudsman for help or advice. This is someone who can explain your health benefits. You can learn more about your rights as a health plan member. The ombudsman can also help you file a grievance or solve an issue. Visit Ombudsman.IN.gov to learn more. You may also call the Member Support Services program for Indiana PathWays for Aging at 1-877-738-3511, TTY 711. If you currently live in a nursing home, contact the State of Indiana’s Long Term Care Ombudsman. That phone number is 1-800-622-4484, TTY 711.

Abuse, neglect, and exploitation
Abuse is a term that means you are being hurt.

Neglect happens when you have trouble getting your basic needs met. This includes things like not being able to visit the doctor, living in an unsafe home, or not having enough food or clothing.

Exploitation happens when someone is taking advantage of you or treating you poorly. This can include removing items from your home, spending your money without your approval, or using your identity.

If you feel that your safety is in danger, call 911 right away. If you are the victim of abuse, neglect, or exploitation, call Adult Protective Services. That phone number is 1-800-992-6978. If UnitedHealthcare learns that your personal safety is in danger, we must report it.

Health Plan Operations
As a member you have the right to know how we do business. Member Services can answer questions. We can send you information about our operations. Health plan operations covers many topics. This includes:

  • All members have a Care Coordinator. Some members also have a Service Coordinator. This person can help you with all your health care needs. This includes answering questions about Indiana PathWays for Aging and other health coverage, like Medicare.
  • You can recommend a change to a service, program, or health plan procedure.
  • You can let us know how to contact you. You may choose mail, email, phone, and text.
  • We can send you information in other languages or formats like braille, audio, and large print.
  • It is your right to choose the medical care you receive. This includes life-saving measures in an emergency. It also includes your wishes during a mental health crisis. An advance health directive is a legal form. On it, you can list what health care you want in case you cannot talk or make decisions later.
  • You have the right to voice complaints about how you are treated or the care you get. Our member handbook has details about grievance, appeal, and fair hearing procedures.
  • We have policies and procedures in place for the things we do. You can ask for these documents.
  • Your Primary Medical Provider participates in a program that encourages them to see our members. It focuses on making sure you receive the care you need. If you would like to receive more details about this program, please contact your Care Coordinator.
  • The member handbook includes our privacy practices. This describes how medical information about you is used.

Members who qualify for services offered through HCBS have access to waiver programs. We offer a flyer that walks through the basics:

If you believe you qualify for a waiver program, talk to your Care Coordinator or contact your local Area Agency on Aging. Here is a map of those agencies by county.

Get health advice from a nurse 24 hours a day, 7 days a week, at no cost to you. Call toll-free at 1-800-832-4643. TTY users may dial 711.

You may be missing adult shots recommended by the CDC (Centers for Disease Control).

We care about your health. Due to certain medication conditions or risk factors you may be at risk for one or more of the following potentially serious diseases:

  • Hepatitis A and B
  • Meningococcal disease
  • Pneumococcal pneumonia
  • RSV (respiratory syncytial virus) – ages 60+
  • Shingles
  • Tdap (tetanus, diphtheria, pertussis)

Shots can help stop these diseases before they start. Please reach out to your primary medical provider or your pharmacist today. You may also visit cdc.gov to learn more.
 


Disclaimer information
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Looking for the federal government’s Medicaid website? Look here at Medicaid.gov.

UnitedHealthcare Dual Complete plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. Benefits, features and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

Premium disclaimer

Dual Special Needs plans have a $0 premium for members with Extra Help (Low Income Subsidy).

Benefit disclaimer

Benefits, features, and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply.

Nurse Hotline disclaimer

This service should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. The information provided through this service is for informational purposes only. The nurses cannot diagnose problems or recommend treatment and are not a substitute for your provider's care. Your health information is kept confidential in accordance with the law. The service is not an insurance program and may be discontinued at any time. Nurse Hotline not for use in emergencies, for informational purposes only.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan)

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. 

UnitedHealthcare Connected® (Medicare-Medicaid plan)

UnitedHealthcare Connected® (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees.

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan)

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and MassHealth (Medicaid) to provide benefits of both programs to enrollees. 

UnitedHealthcare Connected® general benefit disclaimer

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the member handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® member handbook. 

UnitedHealthcare Senior Care Options (HMO SNP) plan

UnitedHealthcare Senior Care Options (SCO) is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare and does not have any other comprehensive health Insurance, except Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our Senior Care Options (SCO) program.

Star ratings disclaimer

Every year, Medicare evaluates plans based on a 5-Star rating system. The 5-Star rating applies to plan year 2024.

Important provider information

The choice is yours

We will provide you with information to help you make informed choices, such as physicians' and health care professionals' credentials. This information, however, is not an endorsement of a particular physician or health care professional's suitability for your needs.

The providers available through this application may not necessarily reflect the full extent of UnitedHealthcare's network of contracted providers. There may be providers or certain specialties that are not included in this application that are part of our network. If you don't find the provider you are searching for, you may contact the provider directly to verify participation status with UnitedHealthcare's network, or contact Customer Care at the toll-free number shown on your UnitedHealthcare ID card. We also recommend that, prior to seeing any physician, including any specialists, you call the physician's office to verify their participation status and availability.

Some network providers may have been added or removed from our network after this directory was updated. We do not guarantee that each provider is still accepting new members.

Out-of-network/non-contracted providers are under no obligation to treat UnitedHealthcare plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services.

American Disabilities Act notice

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 ("ADA"), UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

Referrals

Network providers help you and your covered family members get the care needed. Access to specialists may be coordinated by your primary care physician.

Paper directory requests

Paper copies of the network provider directory are available at no cost to members by calling the customer service number on the back of your ID card. Non-members may download and print search results from the online directory.

Inaccurate information

To report incorrect information, email provider_directory_invalid_issues@uhc.com. This email box is for members to report potential inaccuracies for demographic (address, phone, etc.) information in the online or paper directories. Reporting issues via this mail box will result in an outreach to the provider’s office to verify all directory demographic data, which can take approximately 30 days. Individuals can also report potential inaccuracies via phone. UnitedHealthcare Members should call the number on the back of their ID card, and non-UnitedHealthcare members can call 1-888-638-6613 / TTY 711, or use your preferred relay service.

Declaration of disaster or emergency

If you’re affected by a disaster or emergency declaration by the President or a governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, there is certain additional support available to you.

  • Part A, Part B, and supplemental Part C plan benefits are to be provided at specified non-contracted facilities (note that Part A and Part B benefits must be obtained at Medicare certified facilities);
  • Where applicable, requirements for gatekeeper referrals are waived in full;
  • Plan-approved out-of-network cost-sharing to network cost-sharing amounts are temporarily reduced; and
  • The 30-day notification requirement to members is waived, as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the member.

If CMS hasn’t provided an end date for the disaster or emergency, plans will resume normal operation 30 days after the initial declaration.