Information for Employer-sponsored, Individual, and Exchange plans

Network providers help you and your covered family members get the care needed. Your plan may have limitations regarding accessibility, prior approvals for outpatient services or referrals from your primary care physician to see a specialist, as well as other restrictions imposed by your limited provider network. Access to specialists may be coordinated by your primary care provider. Use the number on the back of your insurance card to confirm benefits or authorization and referral requirements.

How we build our network

UnitedHealthcare networks consist of a variety of primary care and behavioral professionals, specialists, hospitals and other facilities. We make outreach to providers, as needed, in order to recruit them to our network. We also accept requests from employers, members, and providers to accommodate needs and preferences. Our providers meet credentialing standards before they are accepted in our network. To help provide members with reasonable access to providers who meet their needs, we look at the number of providers and the types of services offered within a geographic area. Additionally, we conduct an assessment of how well the network meets members’ cultural needs and preferences, as well as, any special healthcare needs.

Health services from non-network providers paid as network benefits

If specific Covered Health Services are not available from a Network provider, you may be eligible for Network Benefits when Covered Health Services are received from non-Network providers. In this situation, your Primary Physician or other Network Physician will notify us and, if we confirm that care is not available from a Network provider, we will work with you and your Primary Physician or other Network Physician to coordinate care through a non-Network provider. If care is authorized from a non-Network provider because it is not available from a Network provider, you will be responsible for paying only the in-Network cost sharing for the service.

For California Providers Only

Individual facilities or health care providers may disagree with the methodology used to define the cost ranges, the cost data, or quality measures. Many factors may influence cost or quality, including, but not limited to, the cost of uninsured and charity care, the type and severity of procedures, the case mix of a facility, special services such as trauma centers, burn units, medical and other educational programs, research, transplant services, technology, payer mix, and other factors affecting individual facilities and health care providers.

Pursuant to Section 1367.49 of the California Health and Safety Code and Section 10133.64 of the California Insurance Code, a provider or supplier may choose to provide an Internet Web link where a response to the health care service plan's cost and/or quality posting may be found.

Click links below for response:

• Physician Response to Quality
• Physician Response to Cost
• Facility Response to Quality
• Facility Response to Cost

When a provider no longer participates in the network, or has changed participation status, additional liability is likely to result. Soon after the provider changes their status, out of network penalties or increased cost sharing will result. In some cases, extension of in network or greater network benefits may be available.

Limitations on selection of providers

Some hospitals and other providers do not provide one or more of the following services that may be covered under your policy and that you or your family member might need: family planning; contraceptive services, including emergency contraception; sterilization, including tubal ligation at the time of labor and delivery; infertility treatments; or abortion. You should obtain more information before you become a policyholder or select a network provider. Call your prospective doctor or clinic, or call the insurer at (insert the insurer's membership services number or other appropriate number that individuals can call for assistance) to ensure that you can obtain the health care services that you need.

Interpreter services

Interpreter services will be coordinated with scheduled appointments for Covered Health Services in a manner that ensures the provision of interpreter services at the time of the appointment.

For California residents, for Behavioral health services and appointments, under California law, you may also be entitled to free interpretation services. To get help in your language, please call 1-800-999-9585 or call the number on your member identification card. Language interpretation services are available at no cost to the member.

Timely access to care

Providers in our network are required to have appointment availability within specified time frames.

Appointment Type Timeframe

• Urgent Care (prior authorization not required by health plan) 48 hours
• Urgent Care (prior authorization required by health plan) 96 hours
• Urgent appointments (dental provider) within 72 hours of the time of request for appointment
• Emergency services (dental provider) 24 hours
• Non-Urgent Doctor Appointment (primary care provider) 10 business days
• Non-Urgent Doctor Appointment (specialty physician) 15 business days
• Non-Urgent Mental Health Appointment (non-physician) 10 business days
• Non-Urgent Appointment (ancillary provider) 15 business days
• Non-Urgent Follow-up appointment (non-physician mental healthcare or substance use disorder providers) within 10 business days of prior appointment
• Care for non-life-threatening emergency (behavioral health provider) 6 hours
• Non-urgent and preventive dental care appointments (dental provider) 10 business days

Enrollees can file a complaint if they are unable to obtain a timely referral to an appropriate provider. The toll-free telephone number is 1-888-466-2219. The Department of Managed Health Care website is HealthHelp.ca.gov.

Behavioral health paper directory requests

Enrollees, potential enrollees, providers and members of the public may request a printed copy of providers in your area by contacting the Plan by phone, 1-800-999-9585; by email bnswest@optum.com; or by mail: OptumHealth Behavioral Solutions of California P.O. Box 880609 San Diego, CA 92108.

Language Assistance and Nondiscrimination Notice

• California notice of language assistance
• Nondiscrimination notice and access to communication services

UnitedHealthcare has prepared and maintains a network access that describes how the plan monitors the network of providers to ensure that you have access to network providers. The access also has information on the referral processes, complaint procedures, quality programs and emergency services coverage provisions. The network access plan is available at the plan’s office: 169 Inverness Drive West, Englewood, CO 80111 or call (800) 842-4509.

Please note - UnitedHealthcare Vision has providers in every Colorado county except Baca, Bent, Chaffee, Cheyenne, Clear Creek, Conejos, Costilla, Crowley, Custer, Dolores, Elbert, Gilpin, Grand, Hinsdale, Jackson, Kiowa, Kit Carson, Lake, Lincoln, Mineral, Moffat, Ouray, Park, Phillips, Pitkin, Rio Blanco, Rio Grande, Routt, Saguache, San Juan, San Miguel, Sedgwick, Teller, Washington and Yuma.

Connecting Coloradans to Colorado Crisis Services

When individuals are struggling or someone they love is hurting, it’s important for them to get help right away. Colorado Crisis Services is available to all Coloradans, 24 hours a day, 7 days a week, 365 days a year – no matter your age or whether you have health insurance or not.

• Call 1-844-493-TALK (8255)
• Text TALK to 38255
• Chat online at ColoradCrisisServices.org from 4:00 p.m. to midnight, daily.

Tier 1 Monument Health Network (Most Coordinated & Lowest Cost of Care)

• Pay less for services when you receive care from a Tier 1 provider.
• Tier 1 includes multiple primary care practices (more than 150 primary care providers) to serve as your medical home; local hospitals and many local specialists who are either independently owned or affiliated with St. Mary’s Medical Center or Family Health West; and all SCL Health providers and facilities in Denver and surrounding counties.

Tier 2 Regional Network (Participating Network)

• In addition to Tier 1 providers, you can access a network of select Western Slop and Front Range providers. Please note, you may pay more for services received by a Tier 2 provider.
• Emergency care is always covered as a Tier 1 benefit.

Please refer to your Evidence of Coverage to determine cost-sharing amounts applicable to your plan.

Connecticut (Dental)

Network Physicians and providers may not bill you for the difference between their contract rate (as may be modified by our reimbursement policies) and the billed charge. However, out-of-Network providers may bill you for any amounts we do not pay, including amounts that are denied because one of our reimbursement policies does not reimburse (in whole or in part) for the service billed, if they provide you with a copy of the signed out-of-network disclosure in a timely manner as required by the state of Delaware. You may get copies of our reimbursement policies for yourself or to share with your out-of-Network Physician or provider by contacting us at www.myuhc.com or the telephone number on your ID card.

Enrolling in this plan does not guarantee services by a particular provider on this list. If you wish to receive care from specific providers listed, you should contact those providers to be sure that they are accepting additional patients for this plan.

To access a list of Mental Health providers that treat opioid use disorders from myuhc.com, please select Find a Provider, select the Mental Health directory, enter the location, select People, select Area of Expertise, select Substance Use Disorders, and select the Medication Assisted Treatment Area of Expertise filter.

Some customers of UnitedHealthcare have a right to an appointment with an in-network health care provider within a certain number of days. You have this right if:

You buy your health insurance directly or receive it through your employer in the District of Columbia, and the appointment for your first visit with a provider. A first visit includes when you:

• Schedule your first primary care visit with a provider.
• Have changed primary care providers and need to schedule your first visit with a new primary care provider.
• Schedule your first visit with a provider other than your primary care provider, your behavioral health / substance use provider, or your prenatal care provider for specialty treatment.

The District of Columbia has set the standards below for appointments with an in-network provider.

• First appointment with a new or replacement Primary Care physician (within 7 business days)
• First appointment with a new or replacement provider for Behavioral Health treatment, including Substance Use Treatment (within 7 business days)
• First appointment with a new or replacement provider for Prenatal Care treatment (within 15 business days)
• First appointment with a new or replacement provider for Specialty Care treatment (within 15 business days)

If you have trouble scheduling an appointment within the timeframes listed, please call the number on your medical  ID card to speak to a UnitedHealthcare representative. That person will help you schedule an appointment within the timeframes listed.

Looking for state resources?

• In-Network and Out-of Network Urgent Care Centers
  • Access the Florida Health Finder interactive provider/facility tool at the link above or HERE
  • Select “All Types” under Facility/Provider Type
  • Enter “Urgent” in the Name field
  • Click on the SEARCH button for a list of in-network and out-of network urgent care providers.

GA Medical providers who may be leaving our network (Revised: 6/4/2024)
GA Dental providers who may be leaving our network (Revised: 9/1/2024)
GA Behavioral Health providers who may be leaving our network (Revised: 11/22/2024)

UnitedHealthcare Insurance Company Access Plan - Small Group
UnitedHealthcare Insurance Company Access Plan - Large Group

Providers identified as offering telehealth services or virtual care is through the synchronous method, which includes real-time telephone or live audio-video interaction typically with a patient using a smartphone, tablet, or computer. Specific services offered through telehealth or virtual care can be searched by provider specialty in the directory, but should be confirmed with the provider when scheduling.

In some instances, a physician who performs services at a facility contracted by UnitedHealthcare may not himself have a contract with UnitedHealthcare. If a non-contracted physician renders service to you or a covered family member, you may experience higher out-of-pocket costs. To help you avoid these higher costs, the Louisiana Consumer Health Care Provider Network Disclosure Act requires that you have access to information on the network status of anesthesiologists, pathologists, radiologists, emergency medicine physicians and neonatologists at each of our contracted facilities. To access this information when doing a network facility search, start by clicking on the facility name. Thereafter, click on the 'Physician Directory' link and a list of contracted physicians at that facility will be displayed. Any physician the facility may use to treat you who is not on the list is likely to be non-participating with UnitedHealthcare. It is always good idea for you to ask the facility which physicians will be rendering services, and then contact those physicians directly to verify whether they participate with UnitedHealthcare. You can also call Customer Care at the toll-free number shown on your UnitedHealthcare ID card to obtain the same information.

Direct Primary Care Provider Referrals

If a member needs covered health care services, participating providers must accept a referral from a direct primary care provider and they are treated the same regardless of whether the referring physician is a PCP or DPC provider. UnitedHealthcare may require a direct primary care provider making a referral (who is not a member of the carrier’s provider network) to provide information demonstrating that the provider is a direct primary care provider through a written attestation or a copy of a direct primary care agreement with an enrollee. To request a referral to an in-network provider, call the toll-free member phone number on the member health plan ID card.

NexusACO Tiered Benefit Plans

UnitedHealthcare may offer benefit plans, with a tiered benefit network, to commercial members. In a NexusACO plan, members may pay different levels of copayments, coinsurance, and deductibles depending on the tier of the provider delivering a covered service or supply. We may make changes to a provider's tier annually in January.

With a tiered benefit networks, UnitedHealthcare may utilize Total Medical Expenses (as defined in Section 10 of Chapter 12C of the Massachusetts General Laws) [Chiamass.gov] or certain criteria within the Standard Quality Measure Set established by the Center for Health Information Analysis [Mass.gov]. 

Provider Reimbursement

In general, within Massachusetts, UnitedHealthcare currently reimburses its in-network and out-of-network providers based on a Fee For Service model.

Coverage for PANDAS and PANS

Per state mandate, Mass. Gen. Laws ch. 175, sec. 47NN, effective for plans issued or renewed on or after January 1, 2022, UnitedHealthcare will cover the medically necessary treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS). Covered PANDAS/PANS treatment includes, but is not limited to, intravenous immunoglobulin (IVIg) therapy.

For Native American plan members, HIS and 638 health facilities or other tribal health facilities will be included at in-network rates, even if they are not listed as part of the plan network.

If emergency care is needed, please seek care at the nearest hospital, regardless of network status.

Site of Service Clinical Review by a Network Participating Provider

A site of service review can change where services can be obtained. It can also change if a Network provider is available to provide a service.

When a provider no longer participates in the network, or has changed participation status, additional liability is likely to result. Soon after the provider changes their status, out of network penalties or increased cost sharing will result. In some cases, extension of in network or greater network benefits may be available.

In the event that the cost estimate differs from the actual cost of the procedure or service, and you would like an explanation or if you have additional questions, please contact our Customer Service Center at the number on your health plan ID card. If you need help with an insurance question or complaint, then you may contact the Consumer Advocacy Unit of the Oregon Department of Consumer and Business – Insurance Division at (888)877-4894 (toll free), P.O. Box 14480 Salem, OR 97309-0405, website: Division of Financial Regulation: State of Oregon, or email.

We cannot guarantee continued access to a particular provider through the term of your enrollment in the plan. If the provider that you are seeing ceases participating with your plan, we will provide access to other providers with equivalent training and experience.

The choice of a given provider as a PCP may result in access to a limited subnetwork of providers, based on the PCP’s employment or other affiliation arrangements.

Choose Your Physician

It is your responsibility to select the health care professionals who will deliver your care. We arrange for Physicians and other health care professionals and facilities to participate in our Choice Plus Network, a national Network of health care professionals. This national Network of health care professionals is available to you. Our credentialing process confirms public information about the professionals' and facilities' licenses and other credentials, but does not assure the quality of their services. These professionals and facilities are independent practitioners and entities that are solely responsible for the care they deliver.

Pursuant to Texas Administrative Code, Title 28, Chapter 11, Subchapter Q, Section §11.1612 (f)(2), an HMO must provide a website disclosure indicating whether the network meets the network adequacy requirements.

View UnitedHealthcare of Texas, Inc. Network Adequacy Disclosure 
View UnitedHealthcare Benefits of Texas, Inc. Network Adequacy Disclosure 
View Pacific Dental Providers, Inc. Network Adequacy Disclosure

Pursuant to Texas Administrative Code, Title 28, §3.3705 (e)(2), an Insurer must provide a web-based listing indicating that the network meets or does not meet the network adequacy requirements. The web-based listing is informational only. To request services from an out-of-network provider, a covered member, covered member’s provider or authorized representative should call the toll-free member telephone number on the health plan ID card; for mental health and substance use disorder services, a covered member, covered member’s provider, or authorized representative should call the Mental Health phone number on the ID card.

View TX UnitedHealthcare Insurance Company Network Adequacy Listing

Texas facility based physician contract status

View contract status
View contract status - Spanish version

Texas facility-based non-contracted physician claims information

View non-contracted claims information
View non-contracted claims information - Spanish version

Texas facility based physician contract status (Individual and Family Exchange Plans)

View contract status

Behavioral Health – Provider Participation

Joining Our Network : Providers of mental health or substance use services not currently under contract with the managed care organization that are willing to meet the terms and conditions for participation may apply for contracted status and may become contracted after successful completion of credentialing. Please refer provider to providerexpress.com for further details.

Behavioral Health – Utilization Review

There are some services that are not guaranteed until the requirements for utilization review have been completed and documentation of authorization has been issued. Use the number on the back of your card to obtain information on how to seek authorization, if you (and/or your representative) believe the necessary care is not available from contracted providers; initiate a grievance if coverage has been denied, reduced, modified, or terminated; and obtain information concerning the potential consequences if authorization is not obtained.

Behavioral Health – Care Management

Complex Case Management Program: The Complex Case Management Program is for members who could be helped through more intensive coordination of services. This program is intended to help members with complex behavioral health conditions connect with needed services and resources. For additional information about the Complex Case Management Program, please call the number on the back of your insurance card.

View Complex Case Management Program

To locate a gender-affirming treatment provider, use the search terms gender-affirming or transgender. If you are unable to locate a gender affirming treatment provider, call the number of the back of your ID card for assistance.

Telemedicine appointments may be available through your provider including video or audio-only services via phone permitting real-time communication between the patient and healthcare professional for the purposes of diagnosis, consultation, or treatment. Please contact your provider to determine what telemedicine services may be available. 

Beginning January 1, 2023 for audio-only telemedicine services, the covered person must have an established relationship with the provider or has been referred by another provider who has had at least one in-person appointment within the past three years for behavioral health treatment and two years for medical treatment or at least one real-time interactive appointment using both audio and video technology until July 1, 2024 (July date only applies to medical treatment).

View the Access Plan below, as required by the Health Benefit Plan Network Access and Adequacy Act. You may also contact us at 866-633-2446 to request a copy.

Optimum Choice, Inc (OCI)

UnitedHealthcare Insurance Company (UHIC)

Golden Rule Insurance Company (GRIC)

You are strongly encouraged to contact us to verify the status of the providers involved in your care including, for example, the anesthesiologist, radiologist, pathologist, facility, clinic or laboratory, when scheduling appointments or elective procedures to determine whether each provider is a participating or nonparticipating provider. Such information may assist in your selection of provider(s) and will likely affect the level of co-payment, deductible and amount of co-insurance applicable to care you receive. The information contained in this directory may change during your plan year. Please call the Customer Service phone number on your ID card to learn more about the participating providers in your network and the implications, including financial, if you decide to receive your care from nonparticipating providers.

Where can I find plan information in my native language?