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UHC Dual Complete VA-Q001 (HMO-POS D-SNP) Lookup tools

2024 UHC Dual Complete VA-Q001 (HMO-POS D-SNP) Lookup Tools

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We're dedicated to improving your health and well-being. Members have access to specialized behavioral health services, which includes mental health and may include substance use treatment. Coverage services may vary based on eligibility. 

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This search option is only available for desktop users. Note that you can download a list of covered drugs below.

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Formularies

Pharmacy Prior Authorization Request

Submit a Pharmacy Prior Authorization Request to OptumRx.

Appeal a Coverage Decision

If we make a coverage decision and you are not satisfied with this decision, you can "appeal" the decision. An appeal is a formal way of asking us to review and change a coverage decision we have made.

Click here to send an email with your appeal request.

Download the evidence of coverage for this plan and review the grievance and appeals section

Or you may download our drug coverage determination request form fill it out and mail it to us

Pharmacy Direct Member Reimbursement Form

Download a MAPD Prescription Drug Reimbursement Request Form from OptumRx.

Prescription Drug Transition Process

What to do if your current prescription drugs are not on the drug list (formulary) or are restricted in some way

Drugs aren’t on list section

Sometimes, you may take a prescription drug that isn’t on your plan’s Drug List or it’s restricted in some way. Whether you’re a new member or a continuing member, there’s a way to get help.

Start by talking to your doctor. Your doctor can help decide if there’s another drug on the Drug List you can switch to. If there isn’t a good alternative drug, you, your representative or your doctor can ask for a formulary exception. If the exception is approved, you can keep getting your current drug for a certain period of time.

Review your Evidence of Coverage (EOC) to find out exactly what your plan covers. If you’re a continuing member, you’ll get an Annual Notice of Changes (ANOC). Review the ANOC carefully to find out if your current drugs will be covered the same way in the upcoming year.

Whether you’re switching drugs or waiting for an exception approval, you may be eligible for a transition supply of your current drug.

  • You must get your 1-month supply, as described in EOC, during the first 90 days of membership with the plan as a new member OR within the first 90 days of the calendar year if you are a continuing member and your drug has encountered a negative formulary change.
  • You may also be eligible for a one-time, temporary 1-month supply if you qualify for an emergency fill while residing in a long-term care (LTC) facility after the first 90 days as a new member or you have encountered a level of care change.
  • If your doctor writes your prescription for fewer days and the prescription has refills, you may refill the drug until you’ve received at least a 1-month supply, as described in your EOC.

New members

As a new plan member, you may currently be taking drugs that are not on the plan’s formulary (drug list), or they are on the formulary but are restricted in some way.

In instances like these, start by talking with your doctor about appropriate alternative medications available on the formulary. If no appropriate alternatives can be found, you or your doctor can request a formulary exception. If the exception is approved, you may be able to obtain the drug for a specified period of time.

During the first 90 days of your membership in the plan if you are a new member, you can request at least a 1-month supply, as described in your plan’s evidence of coverage.

During the first 90 days of the calendar year if you were in the plan last year and your drug encountered a negative formulary change, you can request at least a 1-month supply, as described in your plan’s evidence of coverage.

Members who have unplanned transitions such as hospital discharges (including psychiatric hospitals) or level of care changes (i.e., changing long-term care facilities, exiting and entering a long-term care facility, ending Part A coverage within a skilled nursing facility, or ending hospice coverage and reverting to Medicare coverage) at any time during the plan year. You can request at least a 1-month supply, as described in your plan’s evidence of coverage.

Continuing members

As a continuing member in the plan, you receive an Annual Notice of Changes (ANOC). You may notice that a drug you are currently taking is either not on the upcoming year’s formulary or is on the formulary but restricted in some way in the upcoming year.

Starting October 15, 2023, you may request a 2024 coverage review. If your request is approved, the plan will cover the drug as of January 1, 2024.

If your drug is subject to new formulary restrictions on January 1, 2024 and you have not discussed switching to an alternative formulary medication or pursued a formulary exception with your doctor, you may receive a temporary supply within the first 90 days of the new calendar year when you go to a network pharmacy. This would be at least a 1-month supply, as described in your plan’s evidence of coverage, to allow you time to discuss alternative treatment with your doctor or to pursue a formulary exception.

If you live in a long-term care facility, you can obtain multiple refills until you’ve reached at least a 31-day supply, including when prescriptions are dispensed for less than the written amount due to drug utilization edits that are based on approved product labeling.

There may be unplanned transitions such as hospital discharges or level of care changes (i.e., changing long-term care facility or in the week before or after a long-term care discharge, end of skilled nursing facility stay and reverting to Part D coverage or when taken off hospice care) that can occur anytime. If you are prescribed a drug that is not on our formulary or your ability to get your drugs is restricted in some way, you are required to use the plan's exception process. For most drugs, you may request a one-time temporary supply of at least one month, as described in your plan’s evidence of Coverage, to allow you time to discuss alternative treatment with your doctor or to pursue a formulary exception.

For members who have been in the plan for more than 90 days and reside in a long-term care (LTC) facility and need a supply right away, we will cover at least a 31-day temporary supply, as described in your plan’s evidence of Coverage.

If you have any questions about this transition policy or need help asking for a formulary exception, contact a member services representative.

For prescription drug transition process information in Spanish, go to Forms and Resources and view section 5.2 of your evidence of coverage (Spanish) for more information.

If you’re out of medication after receiving a temporary transition supply and you’re working with your prescriber to switch to an alternative drug or request an exception, call the number on your member ID card or contact UnitedHealthcare Customer Service. 

Related information

The Coverage Determination Request Form may be found under Appeal a Coverage Decision section on this page.

Medication Therapy Management Program

UnitedHealthcare’s Medication Therapy Management (MTM) program was developed by a team of pharmacists and doctors. This program helps eligible members use their coverage and understand their medications and how to use those medications, by providing members with a comprehensive medication review (CMR) with a pharmacist or other qualified health care provider. It can also help protect members from the possible risks of drug side effects and potentially harmful drug combinations.

How to qualify
What you need to do
What's next

How to qualify
This program is available at no cost. You’ll be automatically enrolled in the Medication Therapy Management Program if you:

  1. take eight (8) or more chronic Part D medications, and
  2. have three (3) or more long-term health conditions, and
  3. are likely to spend more than $1,623 a year on covered Part D medications

OR

  • are in a Drug Management Program to help better manage and safely use medications such as opioids and benzodiazepines

You need to have three or more of these health conditions to qualify for the Medication Therapy Management program.

  • Alzheimer’s disease
  • Bone disease-arthritis (including osteoporosis, osteoarthritis, and rheumatoid arthritis)
  • Chronic congestive heart failure (CHF)
  • Diabetes
  • Dyslipidemia
  • End-stage renal disease (ESRD)
  • Human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS)
  • Hypertension
  • Mental health (including depression, schizophrenia, bipolar disorder, and other chronic/disabling mental health conditions) and
  • Respiratory disease (including asthma, chronic obstructive pulmonary disease (COPD), and other chronic lung disorders)

What you need to do
Within 60 days of becoming eligible for the MTM program, you’ll receive an offer by mail to complete a Comprehensive Medication Review (CMR). You may also receive this offer by phone, email or text.

You can complete the CMR by phone. It takes about 30 minutes. A pharmacist, or qualified CMR provider, will review your medication history, including prescription and over-the-counter medications, and look for any issues.

What's next
After completing a CMR, you’ll receive a packet containing a summary of the review including action items discussed and a list of the medications you are taking and why you take them. This can be helpful when meeting with your doctor or pharmacist. The results may be sent to your doctor. In addition, you will receive information on the safe disposal of prescription medications including controlled substances.   

You can also download a blank Medication List (PDF) for your own personal use.

In addition to the CMR, Targeted Medication Reviews are done at least quarterly. This is done to find possible drug interactions or other medication concerns. Those reviews may be sent to your doctor for review.

MTM is not a benefit of your prescription drug plan, but a Medicare designed program offered at no cost by UnitedHealthcare. For more information on UnitedHealthcare’s Medication Therapy Management program, please call Customer Service (the phone number is on the back of your plan member ID card) or you may call the Optum Rx MTM clinical call center team at 1-866-216-0198, TTY 711, Monday – Friday 9 a.m. – 9 p.m. EST.

To search for a dental provider, click on the link below, then click on "Dentist Locator," and then choose the name of your health plan.

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Find a pharmacy

You may also go to OptumRx to order and manage your prescription drugs online.


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.