As long as your doctor, hospital, or other provider participates in (i.e., accepts payment from) Medicare, you will receive the same level of coverage whether or not the provider is a member of the UHC Group PPO Network. The university-sponsored group Medicare Advantage Base Plan and Medicare Advantage Enhanced Plan provide the flexibility to see providers in or out of network at the same cost. The following chart describes how this works in various situations:
| If your doctor/provider... | Then... | Impact to You |
|---|---|---|
|
The plan will pay for the covered services or care you receive and your provider submits the claim to UHC. | You pay your share of the cost (e.g., your deductible and/or your copay). |
|
The plan will pay for the covered services or care you receive and your provider submits the claim to UHC (same as above). | You pay your share of the cost (e.g., your deductible and/or copay). |
|
The plan will pay for the covered services or care you receive. You may be responsible for filing for reimbursement; contact UHC for assistance. | You may need to pay the entire cost out-of-pocket and submit your claim to UHC for reimbursement. If your provider is not willing to submit your claims to UHC, contact UHC’s university-dedicated toll-free number at 1-866-899-5903, TTY 711, from 8:00 a.m. – 8:00 p.m. in your local U.S. time zone. |
|
Services you receive through that provider will not be covered under the universitysponsored Medicare Advantage plans. Federal regulations bar payments to providers who have fully opted out of Medicare. | You pay the entire amount for any services received from the provider. Generally, the provider asks you to sign a contract confirming this. |
Reviewed 2019-10-17
