April 17, 2015
Area(s) of Interest: Commercial Payors Payor Issues and Reimbursement Practice Management
United Healthcare (UHC) recently issued notifications to 19,000 practices included in its commercially contracted provider network, advising of their inclusion in the UHC Core product. The new UHC Core plan will access a significantly narrowed network and will be marketed to employer groups seeking lower premiums for their employees. Additionally, indications are that UHC will also utilize the narrowed Core network for its potential future exchange products in 2016.
UHC advised the California Medical Association (CMA) that reimbursement for the Core product line will be at the commercial fee schedule rates outlined in the UHC physician agreement. Those providers with multiple fee schedules in their contract will be paid at the fee schedule indicated for the United Healthcare Choice/Choice Plus benefit plans.
UHC also advised CMA that the only option for physicians who wish to opt out of the Core product network is to terminate the underlying UHC commercial agreement. There is no ability to opt out of just the Core network.
Physicians who are unsure about whether or not they are affected by this change, those who have general questions about the notice or those who wish to dispute their participation in the Core plan network can contact UHC Network Management at (866) 574-6088.