UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) Frequently Asked Questions

If you have questions or need to speak with your care manager, please call UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) at 1-877-542-9236 (TTY 711), 8 a.m. – 8 p.m. local time, Monday – Friday (voicemail available 24 hours a day/7 days a week). Click here to learn about Appeals & Grievances.

Medicare Complaint Form

If you have questions or need to speak with your care manager, please call UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) at 1-877-542-9236 (TTY 711), 8 a.m. – 8 p.m. local time, Monday – Friday (voicemail available 24 hours a day/7 days a week). Click here to learn about Appeals & Grievances.

Medicare Complaint Form

Healthchek is Ohio's early and periodic screening, diagnostic, and treatment (EPSDT) benefit.  Healthchek covers medical exams, immunizations (shots), health education, and laboratory tests for everyone eligible for Medicaid under the age of 21 years. These exams are important to make sure that young adults are healthy and are developing physically and mentally. Members under the age of 21 years should have at least one exam per year.

Healthchek also covers complete medical, vision, dental, hearing, nutritional, developmental, and mental health exams, in addition to other care to treat physical, mental, or other problems or conditions found by an exam.  Healthchek covers tests and treatment services that may not be covered for people over age 20; some of the tests and treatment services may require prior authorization. Your doctor must call Utilization Management (UM) at 1-800-366-7304 before you obtain a service or procedure that is listed as requiring an okay.

Healthchek services are available at no cost to members and include:

• Preventive check-ups for young adults under the age of 21.
• Healthchek screenings:
  • Complete medical exams (with a review of physical and mental health development)
  • Vision exams
  • Dental exams
  • Hearing exams
  • Nutrition checks
  • Developmental exams
• Laboratory tests for certain ages
• Immunizations
• Medically necessary follow up care to treat physical, mental, or other health problems or issues found during a screening.  This could include, but is not limited to, services such as:
  • Visits with a primary care provider, specialist, dentist, optometrist and other UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) providers to diagnose and treat problems or issues
  • In-patient or outpatient hospital care
  • Clinic visits
  • Prescription drugs
  • Laboratory tests
  • Health education 

Additionally, care management services are available to all members.  If you have questions or need to speak with your care manager, please call UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) at 1-877-542-9236 (TTY 711), 8 a.m. – 8 p.m. local time, Monday – Friday (voicemail available 24 hours a day/7 days a week).

Emergency services are services for a medical problem that you think is so serious that it must be treated right away by a doctor. We cover care for emergencies both in and out of the county where you live.

Some examples of when emergency services are needed include: miscarriage/pregnancy with vaginal bleeding, heart attacks, severe chest pain, severe bleeding that does not stop, serious breathing difficulties, and possible stroke.  You do not have to contact UnitedHealthcare Connected^® for MyCare Ohio (Medicare-Medicaid Plan) for an okay before you get emergency services. If you have an emergency, call 911 or go to the NEAREST emergency room (ER) or other appropriate setting.

If you are not sure whether you need to go to the emergency room, call your primary care provider or the Nurse Hotline at 800-542-8630 (TTY 711). Your PCP or the Nurse Hotline can talk to you about your medical problem and give you advice on what you should do.

Remember, if you need emergency services:

• Go to the nearest hospital emergency room or other appropriate setting.  Be sure to tell them that you are a member of UnitedHealthcare Connected^® for MyCare Ohio (Medicare-Medicaid Plan) and show them your ID card.
• If you need emergency transportation, contact 911 or your local emergency service.
• If the provider that is treating you for an emergency takes care of your emergency but thinks that you need other medical care to treat the problem that caused your emergency, the provider must call our plan. Those doctors will tell us when your medical emergency is over.
• After the emergency is over, you may need follow-up care to be sure you get better. Your follow-up care will be covered by our plan. If you get your emergency care from
  out-of-network providers, we will try to get network providers to take over your care as soon as possible.
• You will need to call your PCP as soon as possible after the emergency is under control.
• If the hospital has you stay, please call Member Services at 1-877-542-9236 (TTY 711) within 24 hours, or as soon as possible.

After Hours Care or Care When Traveling Outside the UnitedHealthcare Service Area

Sometimes you may need your PCP when the office is closed or when you are traveling outside the UnitedHealthcare Connected^® for MyCare Ohio (Medicare-Medicaid Plan) service area. If you need urgent or non-emergent care, call your PCP's office. You will receive directions on how to access care. There is someone to help you 24 hours a day, seven days a week. If your PCP tells you to go to the nearest emergency room, call UnitedHealthcare Connected^® for MyCare Ohio (Medicare-Medicaid Plan) within 24 hours or as soon as possible.

You can also call UnitedHealthcare Connected^® for MyCare Ohio's (Medicare-Medicaid Plan) Nurse Hotline services. Nurse Hotline nurses are available to answer your health-related questions 24 hours a day and 7 days a week. Call Nurse Hotline at 1-800-542-8630 (TTY 711).

Applicants can ask an authorized representative to apply on their behalf using the forms below:

• Medicare Authorized Representative Form
• Medicare Form to Share Information
• OHIO Authorized Representative Form
• HIPAA Authorization Form

Prior authorization is an okay for services that must be approved by UnitedHealthcare Connected^® for MyCare Ohio (Medicare-Medicaid Plan). Your doctor must call Utilization Management (UM) at 1-800-366-7304 before you obtain a service or procedure that is listed as requiring an okay. Our UM team is available Monday through Friday, 8 a.m. to 5 p.m. On-call staff is available 24 hours a day, 7 days a week for emergency okays.

UnitedHealthcare Connected^® for MyCare Ohio (Medicare-Medicaid Plan) also reviews some of your services and care as they are happening. This is called concurrent review. Examples are when you are:

• A patient in the hospital
• Receiving home care by nurses
• Certain outpatient services such as speech therapy and physical therapy

UnitedHealthcare Connected^® for MyCare Ohio (Medicare-Medicaid Plan) reviews your progress with your doctor to be sure you still need those services or if other services would be better for you.

UnitedHealthcare Connected^® for MyCare Ohio (Medicare-Medicaid Plan) has policies and procedures to follow when the UM team makes decisions regarding medical services. The UM doctors and nurses make their decision based on your coverage and what you need for your medical condition. The goal is to make sure that services are medically necessary, that they are provided in an appropriate setting, and that quality care is provided.

We want to help you stay well. If you are sick we want you to get better.

• UnitedHealthcare Connected^® for MyCare Ohio (Medicare-Medicaid Plan) does not pay employees extra for limiting your care.
• Our network doctors do not receive extra money or rewards if they limit your care.

If you have questions about UM decisions or processes, call Member Services at 1-877-542-9236 (TTY 711).

Your doctor must call Utilization Management (UM) at 1-800-366-7304 before you obtain a service or procedure that is listed as requiring an okay.

A Preferred Drug List (PDL) helps your doctor choose drugs to prescribe for you. If a drug has a generic form, this is what UnitedHealthcare Community Plan will cover. In some cases, you may be able to get drugs that are not on our list if your doctor asks for prior authorization.

In some cases, you may be able to get drugs that are not on our list if you are already taking the medication or if your doctor asks for prior authorization. Call our Member services or look at the Find A drug section of this website to see if your drugs need approval. 

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) covers some OTC drugs with a prescription. The updated OTC list can be found within our Preferred drug List (PDL) under Find A Drug on this website. You can also call Member services with questions.  These are limited to generic drugs when available..

There are a few reasons this could happen.

1. Some covered drugs need prior authorization.
2. Some drugs are called Step Therapy medications. That means you need to try other drugs before this one. These are covered only after other first-line drugs have been tried and failed.
3. Some drugs may be limited to the amount a person can be prescribed in one month.
4. Sometimes, a different strength or type of medicine is covered, such as tablets or liquid.

If you need other drugs, your doctor must get Prior Authorization from UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan). Your doctor has to state how long you have been taking the drug and what other drugs you have tried.

Medicaid is a program for people with low income who meet certain eligibility requirements and programs can vary from state-to-state.

Medicare is a national health insurance program for people ages 65+, or younger individuals with certain disabilities.

UPDATE

Except in limited cases such as emergency care, urgently needed care when our network is not available, or out of service area dialysis, you must obtain covered services from network providers for the services to be covered. If you get non-emergency care from non-network providers without prior authorization, you must pay the entire cost yourself.

If you believe that you meet any of the above criteria and should be enrolled, contact the Medicaid Hotline at  1-866-693-0898 , TTY users should call Ohio Relay at 7-1-1, or on the managed care enrollment center (MCEC) website at www.ohiomh.com . You can also contact Member Services at 1-877-542-9236. (TTY 711), if you have additional questions.

Member Services will help make sure that the PCP you want to switch to is a participating provider with UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan).^. They will also check to be sure the PCP you want to switch to is accepting new patients. Members can change their PCP monthly. If you change during your first month of membership, you PCP change will be effective immediately. After your first month of membership, your PCP change will take effect the first day of the next month. We will send you a new ID card with your new PCP listed. We will also let you know when you can start seeing your new PCP.

Sometimes a PCP, specialist, clinic, hospital or other plan provider you are using might leave the Plan. If this happens, you will have to switch to another provider who is part of our Plan. If your PCP leaves our Plan, we will let you know and help you choose another PCP so that you can keep getting covered services.

This will allow your doctor to schedule other patients.

Update with languge help content

We can help you if you do not speak or understand English. We have representatives that speak different languages.  If you we don't have a representative who speaks your language, we will arrange for a translator or interpreter to help us with your call. Please call Member Services at 1-800-493-4647, TTY 711 and notify our representatives what languages you speak. If you need an interpreter when you visit your doctor, ask the doctors office to arrange for a translator.

If you have a medical emergency:

• Get medical help as quickly as possible. Go to the nearest hospital emergency room or other appropriate setting. Be sure to tell them you are a member of UnitedHealthcare Community Plan and show them your ID card if you are able.
• If you need emergency transportation, call 911 or your local emergency service.
• Make sure that your PCP knows about your emergency, because your PCP needs to be involved in following up on your emergency care. You or someone else should call to tell your PCP about your emergency care as soon as possible.

If you need urgent care, you can visit an urgent care center. You do not need to get an OK before you do. If you need help locating an urgent care center near you, Member Services can help. If you do not know if you need to visit an urgent care center, you can call your PCP or our 24/7 Nurse Hotline services.