UnitedHealthcare Connected® for MyCare Ohio H2531-001 Lookup Tools

Maghanap sa aming direktoryo ng mga physician at pasilidad ng network sa pamamagitan ng pagbibigay ng karagdagang impormasyon sa ibaba.

Mga Direktoryo ng Provider

OH Northeast - Geauga, Lake, Lorain, and Medina Counties

OH Northeast - Cuyahoga County

OH East Central - Portage, Stark, Summit, and Wayne Counties

OH Northeast-Central - Columbiana, Mahoning, and Trumbull Counties

Prior Authorizations

Prior Authorization Request

Download the List of Services that Require Prior Authorization
Download the Prescription Prior Authorization List (Coming Soon)

 

Prior Authorization Process

Prior authorization is an okay for services that must be approved by UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan). Your doctor must call Utilization Management (UM) at 1-800-366-7304 before you obtain a service or procedure that is listed as requiring an okay on pages 19-22. Our UM team is available Monday through Friday, 8 a.m. to 5 p.m. On-call staff is available 24 hours a day, 7 days a week for emergency okays.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) also reviews some of your services and care as they are happening. This is called concurrent review. Examples are when you are:

  • A patient in the hospital
  • Receiving home care by nurses
  • Certain outpatient services such as speech therapy and physical therapy

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) reviews your progress with your doctor to be sure you still need those services or if other services would be better for you.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) has policies and procedures to follow when the UM team makes decisions regarding medical services. The UM doctors and nurses make their decision based on your coverage and what you need for your medical condition. The goal is to make sure that services are medically necessary, that they are provided in an appropriate setting, and that quality care is provided.

We want to help you stay well. If you are sick we want you to get better.

  • UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) does not pay employees extra for limiting your care.
  • Our network doctors do not receive extra money or rewards if they limit your care.

If you have questions about UM decisions or processes, call Member Services at 1-877-542-9236 (TTY 711).

To file an Appeal or Grievance, please visit or FAQ section.

Search for current 2018 drugs covered by UnitedHealthcare Connected™ for MyCare Ohio

Download the 2018 UnitedHealthcare Connected™ for MyCare Ohio Formulary.

Search for 2019 drugs covered by UnitedHealthcare Connected™ for MyCare Ohio

Download the 2019 UnitedHealthcare Connected™ for MyCare Ohio Formulary. 

 

Prior Authorizations

Prior Authorization Request 
Download the List of Services that Require Prior Authorization 
Download the Prescription Prior Authorization List (Coming Soon)

Kahilingan sa Pag-reimburse ng Miyembro ng Pharmacy Direct

Mag-download ng Form ng Kahilingan para sa Pag-reimburse sa Reseta na Gamot ng MAPD mula sa OptumRx. 

Prescription Drugs - Not Covered by Medicare Part D

While most of your prescription drugs will be covered by Medicare Part D, there are a few drugs that are not covered by Medicare Part D but are covered by UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan).  You can view our plan’s List of Covered Drugs on our website at www.myuhc.com/communityplan.  Drugs with an asterisk are not covered by Medicare Part D but are covered by UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan). You do not have any co-pays for non-Part D drugs covered by our plan.

Please note that our list of medications that require prior authorization can change so it is important for you and/or your provider to check this information when you need to fill/refill a medication.

Submit a Pharmacy Prior Authorization Request to OptumRx

Submit a Pharmacy Prior Authorization Request

Proseso ng Pagpapalit ng Inireresetang Gamot

Ano ang gagawin kung wala sa pormularyo o limitado sa pormularyo ang iyong mga kasalukuyang inireresetang gamot.

Mga bagong miyembro
As a new member of an UnitedHealthcare ConnectedUnitedHealthcare Connected™ for MyCare Ohio, insured through UnitedHealthcare, you may currently be taking drugs that are not on the UnitedHealthcare® formulary (drug list), or they are on the formulary but your ability to get them is limited.

Sa mga sitwasyong tulad ng mga ito, magsimula sa pamamagitan ng pakikipag-usap sa iyong doktor tungkol sa mga naaangkop na kahaliling gamot na available sa pormularyo. Kung walang mahahanap na mga naaangkop na kahalili, maaari kang humiling o ang iyong doktor ng pagbubukod sa pormularyo. Kung maaprubahan ang pagbubukod, makukuha mo ang gamot sa loob ng isang partikular na takdang panahon. Habang tinutukoy mo at ng iyong doktor ang iyong magiging pagkilos, maaaring karapat-dapat kang makatanggap ng paunang 31-araw na supply sa pagpapalit (maliban kung isinusulat para sa mas kaunting mga araw ang iyong reseta) ng gamot anumang oras sa panahon ng unang 90 araw na naging miyembro ka ng plano.

Para sa bawat isa ng iyong mga gamot na wala sa pormularyo o kung limitado ang iyong kakayahang makuha ang iyong mga gamot, sasaklawin ng UnitedHealthcare ang 31-araw ng supply (maliban kung para sa mas kaunting mga araw ang iyong reseta) kapag pumunta ka sa isang pharmacy ng network. Kung isinusulat ang iyong reseta para sa mas mababa sa 31 araw, pinapayagan ang maraming pagdagdag nang hanggang sa kabuuan ng 31 araw ng mga gamot. Pagkatapos ng iyong unang 31 araw ng transition supply, hindi maaaring patuloy na saklawin ang mga gamot na ito. Makipag-usap sa iyong doktor tungkol sa mga naaangkop na kahaliling gamot. Kung wala sa pormularyo, maaari kang humiling o ang iyong doktor ng pagbubukod sa pormularyo.

Kung nakatira ka sa pasilidad ng pangmatagalang pangangalaga, sasaklawin ng UnitedHealthcare ang pansamantalang 31 araw ng supply sa pagpapalit (maliban kung para sa mas kaunting mga araw ang iyong reseta). Sasaklawin ng UnitedHealthcare ang mahigit sa isang refill ng mga gamot na ito para sa unang 90 araw para sa mga miyembro ng plano, hanggang sa 93 araw ng supply. Kung kailangan mo ng gamot na wala sa pormularyo o limitado ang iyong kakayahang makuha ang iyong mga gamot, ngunit lampas ka na sa unang 90 araw ng pagiging miyembro ng plano, sasaklawin ng programa ng pagpapalit ang 31 araw ng supply na pang-emergency ng gamot na iyon (maliban kung para sa mas kaunting mga araw ang iyong reseta) habang isinusulong mo ang pagbubukod sa pormularyo.

Maaari kang magkaroon ng mga hindi nakaplanong transition pagkatapos ng unang 90 araw ng pagpapatala sa plano, gaya ng mga paglabas sa ospital o mga pagbabago ng antas ng pangangalaga (hal., sa linggo bago lumabas sa pangmatagalang pangangalaga). Kung nireresetahan ka ng gamot na wala sa pormularyo o limitado ang iyong kakayahang makuha ang iyong mga gamot, hinihiling sa iyong gamitin ang proseso ng pagbubukod ng plano. Maaari kang humiling ng isahang beses na supply na pang-emergency ng hanggang sa 31 araw upang magkaroon ka ng oras upang talakayin ang kahaliling panggagamot sa iyong doktor o upang isulong ang pagbubukod sa pormularyo.

Mga nagpapatuloy na miyembro
Bilang isang nagpapatuloy na miyembro ng plano, nakakatanggap ka ng Taunang Abiso ng Mga Pagbabago (Annual Notice of Changes o ANOC). Maaaring mapansin mong ang gamot sa pormularyo na kasalukuyan mong ginagamit ay wala sa pormularyo ng paparating na taon o limitado ang pagbabahagi ng gastos o saklaw nito sa paparating na taon.

Para sa mga kahilingin sa saklaw na natanggap sa bawat taon bago ang Disyembre 15, at naaprubahan, sasaklawin ng plano ang gamot simula sa Enero 1. Para sa mga kahilingin sa saklaw na pinasimulan sa o pagkatapos ng Disyembre 16, nalalapat ang mga normal na takdang panahon para sa pagresolba: makakatanggap ka ng sagot sa loob ng 24 na oras para sa mga agarang kahilingin at sa loob ng 72 oras para sa lahat ng iba pang kahilingan. Kung kasalukuyan pang pinoproseso ang iyong kahilingan sa Enero 1, maaari kang makatanggap ng pansamantalang supply ng gamot para sa iyong kasalukuyang pagbabahagi ng gastos ng plano hanggang sa masagot ang iyong kahilingan.

Kung mayroon kang anumang mga tanong tungkol sa patakaran sa transition na ito o nangangailangan ng tulong sa paghiling ng pagbubukod sa pormularyo, makatutulong ang isang kinatawan ng UnitedHealthcare.

Nauugnay na Impormasyon
Form ng Kahilingan sa Pagtutukoy ng Saklaw ng Bahagi D ng Medicare - (para sa paggamit ng mga miyembro at provider)
The Coverage Determination Request Form may be found under Appeal a Coverage Decision section on this page.

Programa sa Pamamahala ng Therapy Gamit ang Gamot

Ang programa ng Pamamahala sa Therapy sa Pamamagitan ng Gamot ng UnitedHealthcare ay binuo ng pangkat ng mga pharmacist at doktor upang tulungan ang mga karapat-dapat na miyembro na gamitin nang mas mabuti ang kanilang saklaw at upang pahusayin ang kanilang pag-unawa sa at paggamit ng mga gamot.  Tumutulong din itong protektahan ang mga miyembro mula sa mga posibleng peligro ng mga side effect ng gamot at mula sa potensyal na mapanganib na mga kumbinasyon ng gamot.

Available ang programang ito nang wala kang karagdagang gagastusin.  Awtomatiko kang itatala sa Programa sa Pamamahala ng Therapy Gamit ang Gamot kung ikaw ay:

  • gumagamit ng (8) o higit pang mga pangmatagalang gamot ng Bahagi D, at
  • may tatlo (3) o higit pang mga pangmatagalang kundisyong pangkalusugan, at
  • maaaring gumastos ng mahigit sa $4,044 sa isang taon sa mga saklaw na gamot ng Bahagi D

Sa ibaba ay listahan ng mga kundisyong pangkalusugan na maaaring gawin kang karapat-dapat para sa programa sa Pamamahala ng Therapy Gamit ang Gamot. Kailangan mong magkaroon ng tatlo o higit pa ng mga kundisyong ito upang makwalipika ka para sa programang ito.

  • Diabetes
  • Hypertension (Mataas na Presyon ng Dugo)
  • Pagpalya ng Puso
  • Mataas ang Cholesterol
  • Rheumatoid Arthritis

Nag-aalok ang programa sa Pamamahala ng Therapy Gamit ang Gamot ng UnitedHealthcare ng Komprehensibong Pagsusuri ng Gamot (Comprehensive Medication Review o CMR) para sa lahat ng miyembro sa pamamagitan ng telepono. Susuriin ng pharmacist ang kasaysayan ng medikasyon ng miyembro, kasama ang mga inireresetang gamot at gamot na nabibili nang walang reseta, at tutukuyin ang anumang mga isyu.  Sa panahon ng pagkumpleto ng pagsusuri ng gamot, papadalhan ang miyembro ng Plano ng Pagkilos sa Gamot na ibinubuod ang anumang mga klinikal na alalahanin na tinukoy at Personal na Listahan ng Gamot ng kanilang kasaysayan ng gamot.  Bilang karagdagan, makikipag-ugnayan sa doktor ng miyembro at ibibigay sa kanila ang impormasyong ito. 

Upang tulungan kang subaybayan ang iyong mga gamot, maaari ka ring mag-download ng blangkong Personal na Listahan ng Gamot para sa iyong personal na paggamit.

Maaari ding makatanggap ng kapaki-pakinabang na impormasyon sa mail ang mga miyembro. Maaaring kasama nito ang karagdagang impormasyon tungkol sa kanilang mga gamot at mga suhestiyon mula sa aming mga pharmacist tungkol sa kung paano masulit ang iyong mga gamot at pakinabang. Maaaring kapaki-pakinabang ang impormasyong ito kapag nakikipagkita sa iyong doktor o pharmacist.

Para sa higit pang impormasyon sa programa sa Pamamahala ng Therapy Gamit ang Gamot ng UnitedHealthcare, mangyaring makipag-usap sa isang kinatawan ng UnitedHealthcare (nasa likuran ng iyong ID card ng miyembro ng plano ang numero ng telepono).

Pakitandaang maaaring may limitadong pamantayan sa pagiging karapat-dapat ang mga programang ito at hindi itinuturing na pakinabang.

Paghahanap ng Dental Provider

Humanap ng dentista sa inyong lugar. Mag-click sa "Maghanap ng Dentista" sa ibaba upang simulan ang inyong paghahanap.

Maghanap ng Dentista

Prior Authorization Request 
Download the List of Services that Require Prior Authorization 
Download the Prescription Prior Authorization List (Coming Soon)

Prior Authorization Process

Prior authorization is an okay for services that must be approved by UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan). Your doctor must call Utilization Management (UM) at 1-800-366-7304 before you obtain a service or procedure that is listed as requiring an okay on pages 19-22. Our UM team is available Monday through Friday, 8 a.m. to 5 p.m. On-call staff is available 24 hours a day, 7 days a week for emergency okays.

UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) also reviews some of your services and care as they are happening. This is called concurrent review. Examples are when you are:

  • A patient in the hospital
  • Receiving home care by nurses
  • Certain outpatient services such as speech therapy and physical therapy

UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) reviews your progress with your doctor to be sure you still need those services or if other services would be better for you.

UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) has policies and procedures to follow when the UM team makes decisions regarding medical services. The UM doctors and nurses make their decision based on your coverage and what you need for your medical condition. The goal is to make sure that services are medically necessary, that they are provided in an appropriate setting, and that quality care is provided.

We want to help you stay well. If you are sick we want you to get better.

  • UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) does not pay employees extra for limiting your care.
  • Our network doctors do not receive extra money or rewards if they limit your care.

If you have questions about UM decisions or processes, call Member Services at 1-877-542-9236 (TTY 711).

 

UHCCP_MCO_Brochure_lockup_K

 

To file an Appeal or Grievance, please visit or FAQ section.

Maghanap ng botika sa network ng UnitedHealthcare sa ibaba.

Mga Direktoryo ng Provider

OH Northeast - Geauga, Lake, Lorain, and Medina Counties

OH Northeast - Cuyahoga County

OH East Central - Portage, Stark, Summit, and Wayne Counties

OH Northeast-Central - Columbiana, Mahoning, and Trumbull Counties

Mga Pharmacy

This part of the Directory provides a list of pharmacies in UnitedHealthcare Connected for MyCare Ohio’s network. These network pharmacies are pharmacies that have agreed to provide prescription drugs to you as a member of the plan.

  • UnitedHealthcare Connected for MyCare Ohio Members must use network pharmacies to get prescription drugs.
    • You must use network pharmacies except in emergency or urgent care situations. If you go to an out-of-network pharmacy for prescriptions when it is not an emergency or urgent care situation, including when you are out of the service area, call UnitedHealthcare Connected for MyCare Ohio toll-free Member Services or 24-hour nurse advice line for assistance in getting your prescription filled.
    • If you go to an out-of-network pharmacy for prescriptions when it is not an emergency, you will have to pay out of pocket for the service. Read the UnitedHealthcare Connected for MyCare Ohio Member Handbook for more information.
  • Some network pharmacies may not be listed in this Directory.
    • Some network pharmacies may have been added or removed from our plan after this Directory was published.

For up to date information about UnitedHealthcare Connected for MyCare Ohio network pharmacies in your area, please visit our web site at www.UHCCommunityPlan.com or call Member Services at 1-877-542-9236, TTY users should call 711, 8 a.m. - 8 p.m., local time, Monday - Friday. The call is free.

To get a complete description of your prescription coverage, including how to fill your prescriptions, please read the Member Handbook and UnitedHealthcare Connected for MyCare Ohio’s List of Covered Drugs. You received the List of Covered Drugs in the mail when you became a member of this plan. You may also visit our web site at www.UHCCommunityPlan.com for the drug list.

Identifying pharmacies in our network
Along with retail pharmacies, your plan’s network of pharmacies includes:

  • Mail-Order Pharmacies
  • Home infusion pharmacies
  • Long-term care (LTC) pharmacies

You are not required to continue going to the same pharmacy to fill your prescriptions. You can go to any of the pharmacies in our network.

Mail Order Pharmacy(ies)
You can get prescription drugs shipped to your home through our network mail order delivery program which is called OptumRx® home delivery pharmacy. Prescription orders sent directly from your doctor must have your approval before we can send your medications. This includes new prescriptions and prescriptions refills. We will contact you, by phone, to get your approval. If we are unable to reach you for approval, your prescription will not be sent to you.

You also have the choice to sign up for automated mail order delivery through our OptumRx® home delivery pharmacy. Typically, you should expect to get your prescription drugs from 4 to 6 days from the time that the mail order pharmacy gets the order. If you do not get your prescription drug(s) within this time, if you would like to cancel an automatic order, or if you need to ask for a refund for prescriptions you got that you did not want or need, please contact us at 1-877-542-9236, TTY 711, 8 a.m. - 8 p.m., local time, Monday - Friday.

Home Infusion Pharmacies
You can get home infusion therapy if UnitedHealthcare Connected for MyCare Ohio has approved your prescription for home infusion therapy and if you get your prescription from an authorized prescriber. For more information, please see your Member Handbook, or call Member Services at 1-877-542-9236, TTY 711, 8 a.m. - 8 p.m., local time, Monday - Friday.

Long-Term Care Pharmacies
Residents of a long-term care facility, such as a nursing home, may access their prescription drugs covered under UnitedHealthcare Connected for MyCare Ohio through the facility’s pharmacy or another network pharmacy. For more information, you can call Member Services at 1-877-542-9236, TTY 711, 8 a.m. - 8 p.m., local time, Monday - Friday.

 

Prior Authorizations

Prior Authorization Request
Download the List of Services that Require Prior Authorization 

Prior Authorization Process

Prior authorization is an okay for services that must be approved by UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan). Your doctor must call Utilization Management (UM) at 1-800-366-7304 before you obtain a service or procedure that is listed as requiring an okay on pages 19-22. Our UM team is available Monday through Friday, 8 a.m. to 5 p.m. On-call staff is available 24 hours a day, 7 days a week for emergency okays.

UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) also reviews some of your services and care as they are happening. This is called concurrent review. Examples are when you are:

  • A patient in the hospital
  • Receiving home care by nurses
  • Certain outpatient services such as speech therapy and physical therapy

UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) reviews your progress with your doctor to be sure you still need those services or if other services would be better for you.

UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) has policies and procedures to follow when the UM team makes decisions regarding medical services. The UM doctors and nurses make their decision based on your coverage and what you need for your medical condition. The goal is to make sure that services are medically necessary, that they are provided in an appropriate setting, and that quality care is provided.

We want to help you stay well. If you are sick we want you to get better.

  • UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) does not pay employees extra for limiting your care.
  • Our network doctors do not receive extra money or rewards if they limit your care.

If you have questions about UM decisions or processes, call Member Services at 1-877-542-9236 (TTY 711).

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UnitedHealthcare Connected® for MyCare Ohio H2531-001

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