ACA Addresses Referral Requirement in UnitedHealthcare's New Charter Products
Written by Editor   
Wednesday, December 10, 2014 12:29 PM

ACA is following up on a recent communication from Optum Health to providers announcing the new UnitedHealthcare Charter products.  This portfolio of plans features three offerings with different levels of coverage - Charter, Charter Balanced, and Charter Plus. (These plans are not currently offered in all states, so this may not apply to your area.)  A referral from the patient's PCP is required for treatment to be covered under the Charter Plan, and a lesser benefit with a higher cost share is offered in the Charter Balanced and Charter Plus plans if the patient does not have a referral from their designated PCP to the doctor of chiropractic.  
 

ACA is reaching out to UnitedHealthcare to discuss its concerns and those of our members regarding the PCP referral requirement.  Please note that all Optum participating providers are eligible to treat members of these plans.  As always, ACA opposes any obstacles that impede direct access to care rendered by a doctor of chiropractic. We will provide further details as soon as information becomes available.  
 

In the meantime, when calling to verify member eligibility you should verify that the patient's PCP has recorded the required referral. The Optum™ Utilization Review Submission Process may also be applicable. To determine if an Optum submission is required, please use the "UHC Quick Group Check" utility at www.myoptumhealthphysicalhealth.com.  If you have questions about your participation in these plans, check Optum's website or contact Provider Services at (800) 873-4575.  If you wish to speak with ACA, please email insinfo@acatoday.org or call (703) 812-0225.


SOURCE:  American Chiropractic Association Insurance Relations Newsletter