Overview Network providers render covered services to DSNP members who are qualified MedicareMedicaid beneficiaries UnitedHealthcare Dual Complete is the members primary insurance Medicaid is secondary ID: 1043106
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1. 1UnitedHealthcare Dual Complete® (HMO-DSNP)
2. Overview:Network providers render covered services to DSNP members who are qualified Medicare/Medicaid beneficiaries.UnitedHealthcare Dual Complete is the member’s primary insurance. Medicaid is secondary.UnitedHealthcare Dual Complete must follow CMS regulations and cover all Medicare Part A (hospital stay) and Part B (doctor’s office) benefits and must include Medicare Part D (pharmacy) coverage.Enrollment:Year round enrollmentMedicare/Medicaid eligible Enrollees can enroll at any time!UnitedHealthcare Dual Complete® (HMO-DSNP)
3. Who is Eligible?Must have Medicare Parts A & BReside in the plan service areaMust not have End Stage Renal Disease (ESRD) - generallyMust have specific level of Medicaid eligibility to participateLevel of eligibility defined by the local Medicaid agencyUnitedHealthcare conducts a pre-enrollment Medicaid eligibility check If enrolled in a Medicaid Health Plan, the enrollee will have UnitedHealthcare Dual Complete + UnitedHealthcare Community PlanMember Eligibility
4. Service Area Map2018 Service Area Counties are Berrien, Branch, Hillsdale, Gratiot, Tuscola, and WashtenawAsk about participation in our UnitedHealthcare Dual Complete network today!
5. Plan Benefit StructureDual CompleteMedicare Advantage Parts A, B & DDual CompleteMedicare Advantage Value Added BenefitsMedicaid Benefits (FFS or Managed)Acute carePhysician servicesSkilled nursing facilityAcute home healthDurable medical equipmentDrug coverageBehavioral HealthHealth & Wellness catalogComprehensive dentalRoutine visionRoutine hearing/hearing aidRoutine transportationNurseLineAcupunctureChiropracticMedicare cost share covered for all membersAdditional coverage beyond Medicare limitsAdditional Medicaid benefits
6. Value Added BenefitsHealth & Wellness Catalog: Catalog credit of $270/quarter - 1,080 year. Annual expirationDental: $1,500 annually; covers exams, x-rays, cleanings, fillings, crowns, periodontal services, extractions, oral/maxillofacial surgery and moreVision: Annual exam and $200 credit every two years for eyewearHearing: Annual exam and $2,000 credit every two years for hearing devicesAcupuncture: up to 10 visits; combined with chiropractic; $0 per visitChiropractic: up to 10 visits; combined with acupuncture; $0 per visitNurseLine: Available 24/7 PERS: Personal Emergency Response System; Available 24/7 no additional costTransportation: 24 one-way rides for health care visits and prescription needs
7. Routine TransportationCall: 1-866-418-9812Request rides or gas reimbursementBest to call four days in advanceOnline: https://member.logisticare.com/login.aspx?ReturnUrl=%2fMembers can log-in to request rides or mileage reimbursement 24 hours a day, 7 days a weekNew! LogistiCare Trip Manager: Downloadable to mobile devices from the Apple App Store or Google PlayNew! Call: 1- 866-535-0155 Where’s My Ride? Member hotline when there is an issue with a scheduled rideRide is at least 15 minutes lateMembers should never call the driver directly“Will call” members call to arrange a pick-up after their appointment with the understanding that pick-up will be in one hourHospital discharge: must allow three hours for pick-up7
8. Behavioral Health BenefitsUnited Healthcare Dual Complete includes Behavioral Health benefits. These services must be provided by an Optum Behavioral Health Services contracted provider. Acute inpatient hospital for Mental Health (MH) and Substance Use Disorder (SUD)Follow Medicare hospital days rules Inpatient free-standing psychiatric facility190 lifetime daysMH/SUD Partial HospitalizationMH/SUD Intensive OutpatientElectroconvulsive Therapy Transcranial Magnetic Stimulation Psychological Testing Home HealthOutpatient Covered Services
9. UnitedHealthcare Dual CompleteID CardFront Back9
10. UnitedHealthcare Dual CompleteImportant InformationProvider Call Center: 1-844-368-6885Claims: Appeals:UnitedHealthcare Community Plan UnitedHealthcare Community PlanAttn: Claims Attn: Appeals & GrievancesP.O. Box 30991 P.O. Box 31664Salt Lake City, UT 84130-0991 Salt Lake City, UT 84131-0364 Behavioral Health: Optum Behavioral Health Services Phone: 844-368-6885Hours: Monday – Friday, 8 a.m. to 6 p.m. local timeOnline: https://www.providerexpress.com/ Dental: UnitedHealthcare DentalPhone: 844-368-6885Hours: Monday – Friday, 8 a.m. to 6 p.m. local timeHearing: EPIC Hearing HealthCarePhone: 1-866-956-5400, TTY 711Hours: Monday – Friday, 6 a.m. - 6 p.m. PTOnline: www.epichearing.com Non-Emergent Transportation: LogisticarePhone: 866-418-9812Hours: Monday – Friday, 8 a.m. to 5 p.m. local timeOnline: Logisticare.com OptumHealth NurseLine Phone: 877-440-9407Hours: 7 days a week, 24 hours a dayVision: March VisionPhone: 844-586-2724Hours: Monday – Friday, 8 a.m. to 5 p.m.Online: https://www.marchvisioncare.com/