Frequently asked questions about the HealthSelect transition
Updated October 1, 2012
Transition Announcement
United HealthCare Services, Inc. became the third-party administrator (TPA) of HealthSelect on September 1, 2012. UnitedHealthcare processes claims, provides customer service, offers health and wellness programs, and manages the HealthSelect network.
About UnitedHealthcare
1. Where is UnitedHealthcare located?
UnitedHealthcare’s dedicated call center for HealthSelect members is located in San Antonio, Texas. Clinical resources, such as disease and health management, will operate out of Richardson, Texas.
2. Are my HealthSelect claims processed overseas?
ERS does not allow UnitedHealthcare or any of its subcontractors to do any work offshore. Your claims will be processed in UnitedHealthcare’s Atlanta, Georgia claims office.
3. Where can I get more information?
You can call UnitedHealthcare HealthSelect Customer Service toll-free at (866) 336-9371 or visit the HealthSelect website.
4. When will I have access to my claims information on the UnitedHealthcare website?
You can go to the HealthSelect website and create your myuhc.com/hs account. You have access to the health and wellness information and discounts, the health risk assessment, and your claims for dates of service on or after September 1, 2012. You will also be able to see referrals approved on September 1 and after. Although Plan Year 2012 referrals that go beyond August 31 to a UnitedHealthcare network provider transferred from Blue Cross and Blue Shield of Texas (BCBSTX) to UnitedHealthcare, you will not be able to see those referrals on your myuhc.com/hs account.
To see your claims for services prior to September 1, log into your Blue Access for Members (BAM) account or call BCBSTX toll-free at (800) 252- 8039. HealthSelect members will have access to their BAM accounts and BCBSTX customer service for an 18-month period through February 2014.
5. Can I choose to get my Explanation of Benefits (EOB) online?
Yes. When you register your online account, you will automatically be signed up to receive only electronic EOBs. If you want to change your preference to receive paper mail, click on Account Settings and choice the paper mail option.
Coverage and Costs
6. Will I pay more out-of-pocket when I go to the doctor?
You may pay more or less than you’ve paid out-of-pocket for the same services at the same provider with the changing to the TPA. The TPA contracts with providers individually and the allowable amounts could differ per doctor, per procedure. For example, if UnitedHealthcare’s allowable amount for your provider to perform an x-ray is $100 and you pay a 20% coinsurance cost, then your cost is $20. However if your provider’s allowable amount for an x-ray is $120, then you will pay $24 in coinsurance.
7. Are the copays, deductibles, or out-of-pocket maximums changing?
No. Copays, deductibles, and out-of-pocket maximums are not changing for Plan Year 2013.
8. Will my non-network and out-of-area deductibles and out-of-pocket maximums that I paid through August 31 transfer to UnitedHealthcare?
Non-network and out-of-area deductibles and out-of-pocket maximum information transferred from Blue Cross Blue Shield to UnitedHealthcare automatically. Non-network deductibles, out-of-area deductibles, and out-of-pocket maximums start over on January 1, 2013.
9. If I travel outside the United States, will I have emergency coverage?
Yes. You will continue to have emergency coverage when you travel outside the United States.
10. What about my prescriptions?
Your prescription drug benefit is not changing as part of this transition. Caremark will continue to manage the HealthSelect prescription drug program.
11. Why doesn’t HealthSelect cover certain items, such as acupuncture and eye glasses?
All health plans have certain conditions and procedures that are excluded from coverage. ERS attempts to serve the greatest number of HealthSelect members with the limited dollars we are provided by the state. In doing so, some procedures and services must be excluded. Such exclusions are part of the plan design determined by ERS.
Referrals and Pre-authorizations
12. How does the referral process work?
If you need to see a specialist, you need to get a referral from your PCP to receive network benefits. Your PCP will submit the referral information to UnitedHealthcare. UnitedHealthcare’s standard length for a referral is six months. If you need to see your specialist beyond the amount of time listed on your referral, you will need to contact your PCP and request a new referral. If you have a chronic condition, your PCP can request a maximum of 99 visits for a six-month period. Any unused visits expire after six months. At that time, your PCP can request a new referral.
For Chiropractic care, your plan allows 30 visits per plan year. Your PCP can submit a referral for up to six visits per referral (with a maximum of 30 visits per plan year). If you need additional care, after you use all six visits from your referral, your PCP will need to request a new referral.
13. Does my physical therapy require a referral?
No. Physical therapy requires a pre-authorization from your doctor to UnitedHealthcare, but it doesn’t require an actual referral.
14. Is a PCP and a referral to a specialist still required for network benefits?
Yes. You must designate a PCP for network benefits to apply to your office visit. You will continue to get referrals to most specialists. You will not need a referral for your annual eye exam or any OB/GYN appointments.
15. Do I still have to get pre-certifications for hospital stays?
Yes. Your provider will need to get pre-authorization for any planned hospital stay.
16. Do I need a referral to my behavioral health provider?
If you go to a network behavioral health provider, you do not need a referral for office visits. Pre-authorizations for in-patient behavioral health care are still required.
Providers
17. Can I search for a provider by ZIP Code using the online search tool?
Yes. Click on “Find a physician near you”, then click on the type of doctor you want to see under “Physician Specialty”. Then, you can enter a ZIP Code and a radius of miles to include in your search.
18. Can I use the online provider search tool to see if my behavioral health provider is in the network?
Yes. Click on “Find a Mental Health Provider” to search for a provider by name or behavioral health specialty.
19. What is liveandworkwell.com?
If you are using the online provider search tool for a mental health specialist, you will be redirected to United Behavioral Health (UBH) clinicians and facilities at liveandworkwell.com.
20. If I don’t see my doctor listed, can I ask UnitedHealthcare to contact my doctor to join?
Yes. Provider nomination instructions have been added to the provider search webpage on the HealthSelect website.
21. What if my doctor isn’t in the network?
If you used a network or ParPlan doctor in the past and that doctor is not part of the UnitedHealthcare network and you continue to see that doctor, you will pay more out-of-pocket costs.
HealthSelect requires participants to seek initial care through a network PCP in order to receive the highest level of paid benefit. UnitedHealthcare continues to add to its network of 57,000 professional providers, focusing on the Blue Cross Blue Shield of Texas providers our members were using. We believe that any potential disruption from the PAR network will be minimized by UnitedHealthcare’s larger network and ongoing recruitment efforts, and a plan design that incentivizes in-network utilization.
22. How can I find out what PCP I have designated now?
Your PCP is listed on your HealthSelect ID card. You may also call UnitedHealthcare toll-free at (866) 336-9371 to find out who is designated as your PCP.
23. Can I call UnitedHealthcare and designate a new PCP?
Yes. You may call UnitedHealthcare toll-free at (866) 336-9371 now and make a PCP designation. If you need to find a PCP in the UnitedHealthcare network, you can also visit the HealthSelect website.
24. How do provider reimbursements work?
HealthSelect is a self-funded managed care Point of Service (POS) plan. The TPA of the HealthSelect plan negotiates with network providers and determines the individual provider reimbursement rates. ERS does not set the provider reimbursements and expects the TPA to negotiate provider reimbursements to make the most use of our limited plan dollars.
25. My behavioral health provider wants to join the UnitedHealthcare network. How does she join the network?
If your behavioral health provider wants to join the UnitedHealthcare network, he or she should call the toll-free UnitedHealthcare number and ask to be part of the “ERS HealthSelect behavioral health network”.
Wellness information
26. Is there a nurseline?
Yes. HealthSelect members have a 24/7 nurseline. The number is toll-free (877) 731-8306. You also have an online nurse-chat option through your myuhc.com/hs account.
27. Are there case management programs?
Yes. HealthSelect members have case management programs available and can enroll in those programs by calling the UnitedHealthcare HealthSelect toll-free number at (866) 336-9371 (TTY users call 711) for more information.