UnitedHealthcare Community Plan

When you join as a new member, UnitedHealthcare wants you to become familiar with all the benefits and resources available to you as a member. This welcome letter provides a brief overview of the plan and what to expect as a UnitedHealthcare member.

Coming Soon. 

If you have questions about your health plan, please call us. Our toll-free Member Services number is 1-800-493-4647, TTY 711. We are open Monday through Friday, 8 am to 6 pm EST.

For a Mental Health or Substance Abuse Crisis dial the member services number then press 8.

Search for a Provider

There are many ways to choose a health care provider. It is important to find providers who are a good fit for you. Ideas include:

• Talk to a friend or family member about who they see.
  
• Call the provider office and ask questions.
• Choose based on where the office is located. 
• View a list of providers that accept your health plan 

Wewant you to feel good about the quality of the providers you choose. Health care providers include:

• Primary Medical Providers (PMPs)
  
• Specialists
• Behavioral health providers
• Dentists
• Eye doctors
• Hospitals
• Urgent care clinics
• Labs
• Medical equipment companies

Of course, you can also call your Member Services Advocate at 1-800-493-4647. We will help you make the choice that’s right for you.

Medical questions and situations sometimes happen at inconvenient times. When you have questions about your health, you can call a nurse 24 hours a day, 7 days a week: 1-877-597-7801, TTY 711.

Our nurses will:

• Listen to your symptoms
• Help with self-care
• Advise if you can get care at your next doctor visit or need an urgent care center
• Help you know when it is time to go to the emergency room

myUHC.com/CommunityPlan

This is your secure member website. See your covered benefits, search for providers, view your member handbook and much more.

It’s designed for people on the go and includes many of the same features as the member website. Find it at the App Store or Google Play.

Getting to the doctor when you are healthy is important. We have guides to help you know what to expect at each well visit. You can also talk to your Member Services Advocate for support and information.

We also have helpful guides for most health problems and conditions. You can also talk to your Member Services Advocate for support and information.

Our educational materials can be found on myuhc.com/CommunityPlan.

You will find condition-specific and general health topics, including:

• Physical Health
  
• Arthritis
  
• Asthma
• Cancer
• Children's Health
• Chronic Pain
• Diabetes

For information on HIV and on HIV counseling, testing, referral, and partner notification (CTRPN) services including Perinatal HIV Prevention & Newborn Screening see the link to the NYSDOH web site below:

HIV Testing (ny.gov)

Additionally, the link below to the AIDS Institute will provide consumer information you might find helpful:

AIDS Institute (ny.gov)

UnitedHealthcare Community Plan members are not responsible for payment for any covered services. Some services may have small co-payments, which can be waived if you cannot afford them.

You should not pay out-of-pocket upfront for any services. There are no out-of-network benefits except in a few cases. A surprise medical bill certification form may be required at those times. See your member handbook for times when you can go to an out-of-network provider. Reimbursement is not guaranteed.

If you have received a bill for covered services or need help fining a participating provider, please call us at 1-800-493-4647, TTY 711 for assistance. 

Notice:

New York State Department of Health has stated – Medicaid recipients should receive breast cancer surgery services at high volume facilities (those facilities performing 30 or more mastectomy and lumpectomy procedures associated with a breast cancer diagnosis on average over a three-year period).

See the listing of low-volume facilities that will not be reimbursed for breast cancer surgeries provided to Medicaid recipients.

This policy does not affect a facility's ability to provide diagnostic or excisional biopsies, and post–surgical care (chemotherapy, radiation, reconstruction, etc.) for Medicaid patients.

Clinical Practice Guidelines

UnitedHealthcare Community Plan has practice guidelines that help providers make healthcare decisions. These guidelines come from nationally recognized sources. UnitedHealthcare Community Plan has practice guidelines for preventive health and other health conditions.

Call our Member Services at 1-800-493-4647 (TTY: 711) to request a printed copy.

Our Healthy First Steps program makes sure that both mom and baby get good medical attention. 

We will help you: 

• Get good advice on nutrition, fitness and safety
• Choose a doctor or nurse midwife
• Schedule visits and exams
• Arrange rides to doctor’s visits
• Connect with community resources such as Women, Infants and Children (WIC) services
• Get care after your baby is born
• Choose a pediatrician (child’s doctor)
• Get family planning information

Behavioral health is about how you feel and act. It is also called mental health. Your mental health is very important. The UnitedHealthcare Community Plan of New York includes mental health and substance use disorder services. You or your provider can call Optum Behavioral Health anytime for help at 1-844-206-1399.

Covered services include:

• All inpatient mental health and substance use disorder services (including alcohol and substance use disorder).
• Most outpatient mental health services (contact plan for specifics).
• Medicaid recipients who receive SSI or who are certified blind or disabled get mental health and substance use disorder services from any Medicaid provider by using their Medicaid Benefit Card.
• Detoxification services are covered by UnitedHealthcare Community Plan as a benefit.

Benefit Update for Children and Family Treatment and Support Services (CFTSS)

Starting January 1, 2020, UnitedHealthcare Community Plan will cover more Children and Family Treatment and Support Services (CFTSS). These services help children and their families improve their health, well-being, and quality of life. 

Harm Reduction Services

Starting July 1, 2018, you will be able to get Harm Reduction Services as part of your Medicaid Managed Care benefit package. Harm Reduction Services will offer a complete patient-oriented approach to the health and wellness of substance users.

Quitting is hard, but we can help. Did you know that 20 minutes after you quit, your heart rate drops to a normal level? And within 24 hours after quitting the carbon monoxide level in your blood drops to normal.

Talk to your doctor about quitting. You know the bad health effects of smoking.

You know you need to quit. We support you while you quit with the help of coaches and supplies. The only thing you won't get from us is a lecture.Or call 1-800-QUIT-NOW (1-800-784-8669) to get free coaching, counseling and supplies to help you quit.

Being healthy is not always about your urgent medical needs. Sometimes you may need help connecting to resources out in the community. We call these social needs. These are things like housing, getting food every day or feeling safe. We can also help you with finishing your education. You can call your Member Services Advocate for more information. Or you can visit findhelp.org

We also offer special programs that include:

• Low-cost internet service at home
  
• Free phone service through SafeLink/TracFone Wireless
• Money back if you use alternative medicine, such as home herbal remedies, vitamins, acupuncture or therapeutic massage
• On My Way online program that guides and supports teens as they start their journey to independence and adulthood

Advance directives are instructions you give about your future medical care in case there is a time you can’t speak or make decisions for yourself. They help your family and physician understand your wishes. 

With advance directives, you can: 

• Let your doctor know if you would or would not like to use life-support machines 
  
• Let your doctor know if you would like to be an organ donor 
• Give someone else permission to say “yes” or “no” to your medical treatments 

Advance directives are only used if you can’t speak for yourself. It does not take away your right to make a different choice if you later become able to speak for yourself. 

You can make an advance directive by: 

• Talking to your doctor and family 
  
• Choosing someone to speak or decide for you, known as a health care representative 
• Creating a Power of Attorney and/or Living Will

You can look at advance directive and health care proxy forms here:

Advance Directives

Health Care Proxy

UnitedHealthcare Community Plan provides member materials to you in a language or format that makes it easier for you to understand. Our provider network includes many doctors who are multilingual.

Our provider directory shows which languages doctors speak. Additionally, many of our Member Services Advocates speak multiple languages, so when you call they will be able to help you or connect you with our interpreter service which covers more than 170 languages.

If you have trouble hearing over the phone you can use a text telephone. This free service allows persons with hearing or speech disabilities to place and receive telephone calls. Call 711, give them the Member Services number, 1-800-493-4647, and they will connect you to us.

You can also get information in large print, Braille or audio files on a CD. We can also assist with interpreter services, including American Sign Language. To ask for help, please call us Monday through Friday, 8 am to 6 pm EST.

Our toll-free Member Services number is 1-800-493-4647, TTY: 711.

We have a Notice of Privacy Practices that tells you how health information about you may be used and shared. We are required by law to let you know that the Notice is available, and how you can get a copy of it. View a copy of our Notice of Privacy Practices 

We want to hear from our members about any questions, complaints or concerns you may have. If you have a grievance, please call Member Services toll-free, at 1-800-493-4647, TTY 711.

If you are not happy with the response from your Member Services Advocate, Care Manager or Member Services, you may file a grievance. You may file a complaint or grievance against us (the health plan) or a provider with us at any time. 

Members may file a grievance verbally with their Member Services Advocate from 8 am to 6 pm EST, Monday through Friday, at 1-800-493-4647, TTY 711. All members can file a grievance through this process. 

You have other rights that include appeals and a State Fair Hearing. For detailed information about complaints and appeals, contact Member Services or view the Appeals and Grievances section of the Member Handbook.

Fraud, waste and abuse are serious problems. There can be penalties under law. To make a report, call the UHC Fraud Hotline at 1-844-359-7736. You can also call Member Services at 1-800-493-4647. We will not use your name in your report. You will not get in trouble for reporting this. We will look into the matter for you. 

More information about fraud, waste or abuse, or to make a report online.