COVID-19 Prior Authorization and Ongoing Patient Care Updates
UnitedHealthcare - May 7, 2020

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UnitedHealthcare is working to help people access health care to the fullest extent possible as we come together to address this national emergency. We’re adopting measures that will reduce administrative burden for physicians and facilities and help members more easily access the care they need under their benefit plan.

NEW – Waiving Cost Share for Medicare Advantage Members for Both Primary and Specialty Care Office Visits

UnitedHealthcare is waiving cost share (copays, coinsurance and deductibles) for UnitedHealthcare Medicare Advantage plan members for all office-based professional services performed by both primary care physicians and specialists. This applies for dates of service starting May 11, 2020 until at least Sept. 30, 2020. Waiving cost share for primary care and specialty care, along with our telehealth cost share waiver, can make it easier for members to get the care they need, however they choose to access it.

Eligible Services

The waiving of cost share for Medicare Advantage members applies to professional services performed by both primary care physicians as well as specialists, no matter the diagnosis or reason for the visit. It applies to the following categories:

  • Primary care physician office visits
  • Specialist physician office visits
  • Physician assistant or nurse practitioner office visits
  • Chiropractic and acupuncture services (Medicare-covered)
  • Eye exams, hearing exams and podiatry visits (Medicare-covered or additional covered benefits)
  • Physical therapy, occupational therapy and speech therapy in an office or outpatient setting
  • Cardiac and pulmonary rehabilitation services in an office or outpatient hospital setting
  • Outpatient mental health and substance abuse visits in an office or outpatient setting
  • Opioid treatment services in an office, outpatient hospital or opioid treatment center setting

However, member cost share is not waived in any place of service for:

  • Inpatient services, outpatient surgery and observation
  • All skilled nursing services
  • All home health services
  • Lab and diagnostic tests (radiological and non-radiological)
  • Part B and Part D drugs
  • Durable medical equipment/prosthetics/supplies
  • Renal dialysis

Cost share is waived for covered services from a network provider or covered out-of-network services.

Eligible Members

The waiving of cost share applies to all UnitedHealthcare Medicare Advantage members, including Group and all Special Needs Plan (SNP) members.

As needed, UnitedHealthcare is also adjusting programs and services to protect members and help limit the spread of the COVID-19 virus in communities. They may also temporarily suspend or relax additional policies as needed in regions where inpatient capacity is most compromised and at risk.

Systems are being updated to reflect these changes. Please check back HERE often for the latest information.