UnitedHealthcare (UHC) is a leading health insurance company in the United States, offering a wide range of healthcare products and services to individuals, employers, and Medicare beneficiaries. UHC's PPO (Preferred Provider Organization) network allow members all over the world to access world-class healthcare even when traveling. If you're wondering how to use UHC's PPO Network while visiting the U.S., you're not alone. We'll walk you through some background information on the company and the network, and then dive into how to use your UHC PPO Network with your travel medical insurance plan as well as how to file a claim.
History and Background of UnitedHealthcare PPO Network
UHC was founded in 1977 with the goal of helping people receive the medical care they needed at a price they could handle. Today, UHC serves millions of members and has established itself as one of the largest and most reputable health insurance companies in the United States.
UHC PPO Network Reputation and Size
UHC's PPO network are known for their extensive size and stellar worldwide reputation. UHC's PPO network of providers includes physicians, hospitals, specialists, and other healthcare professionals. UHC's extensive PPO Network allows people to travel far and wide and still have access to premium healthcare.
UHC's PPO network are also known for their high-quality providers. UHC carefully selects and contracts with providers based on their credentials, expertise, and commitment to delivering quality healthcare services. This helps ensure that UHC members have access to a network of reputable providers who meet UHC's stringent standards.
How Billing Works Within the UHC PPO Network
Understanding how billing works within the UHC PPO network is crucial for UHC members to effectively manage their healthcare expenses and their visitors insurance plan. Here is a step-by-step guide to understanding the entire process, starting with selecting a provider and ending with what to do should you need to file an appeal on a rejected claim.
Step 1: Verify Network Participation
If you are injured while abroad and need urgent medical attention, before receiving services, you should find a provider within the PPO network by registering on the insurance provider's portal and selecting provider lookup to search for a medical facility, physician or specialist. You can also call to verify the medical provider is within the PPO network by providing your insurance ID card prior to the appointment, if it is for preplanned eligible medical conditions. This helps ensure that the services will be covered at the in-network rate, which is typically lower than out-of-network rates.
Step 2: Receive Services
Be sure to bring both a photo ID and your insurance ID card to present to the medical provider if needed. The medical provider should then verify the insurance. Once you receive healthcare services from an in-network provider, the provider will likely submit a claim to UHC for payment. However, depending on the medical provider you may be required to pay up front and then file a claim with your insurance provider once you return home. So you should be prepared to pay for the services at the time they are given and then file a claim for reimbursement. It's crucial that you retain copies of all your medical bills, receipts and doctor's notes as you may need to submit them as supporting documents when filing your claim.
Step 3: Claim Processing
Whether you or your provider submit the claim, UHC will process and review it for accuracy, including verifying that the services rendered are covered under your plan and that the provider is in-network. UHC also applies any applicable copayments, deductibles, or coinsurance based on the plan.
Step 4: Explanation of Benefits (EOB)
You'll receive the EOB, which outlines the amount billed by the provider, the allowed amount based on the negotiated rate, and your share of the costs. You should review the EOB for accuracy and contact UHC if there are any discrepancies.
Step 5: Provider Payment
The medical provider will be paid directly for the allowed amount based on the negotiated rate. The medical provider should be prohibited from billing you for any amount above the allowed amount, as per the terms of the contract with UHC.
Step 6: Member Responsibility
You are responsible for any copayments, deductibles, or coinsurance as outlined in the plan, as well as any non-covered services. You should pay your share of the costs directly to the provider, if applicable, based on the information provided in the EOB.
Step 7: Appeals and Inquiries
If you disagree with the claim processing or payment outcome, or if you have any questions or concerns, you can contact the insurance administrator to initiate an appeal or inquiry. UHC will review the matter and provide a resolution in accordance with your plan and applicable regulations.
By following this step-by-step guide you should be able to navigate the healthcare system with confidence and avoid unexpected costs. If you need assistance, reach out to UHC's customer service specialists. Alternatively, if you acquired your policy through our marketplace, our Customer Success Team is available to field questions as well.