UnitedHealthcare

Information regarding accepted UnitedHealthcare (UHC) insurance plans.

Insurance Definitions

UnitedHealthcare (UHC) Plan Names

Can I choose or visit a Virginia Mason primary care provider (PCP) under this insurance plan?

If I need to see a specialist or have a specialty service, does this insurance plan require pre-approved referral authorization?

(Applicable to Urgent Care Locations as Well)

General Comments

* Please review comments if an asterisk is present.

Community Plan Healthy Options (HMO)

* Yes

* Yes

  • * Not accepting new patients for primary care selection.
  • * Accepting only for patients already established in primary care.
  • Accepting for psychiatry.

* Insurance approved referral is not needed if patient selected a Virginia Mason PCP.

* Approved referral are required when patient has a PCP under the following groups:
  • Highline Medical Services Organization
  • NW Physicians Network

 

Unitedhealthcare Options (PPO)

Yes

No

 

Choice and Choice Plus (PPO)

Yes

No

 

Signature Value West (HMO)

* Yes

* Yes/No

* This program is geographically specific. For example: If a patient buys the coverage in California, they are only covered in California, if they buy it in Washington state, they are only covered in Washington state (unless emergency). They may only select a Virginia Mason PCP if they have the coverage in Washington state. If needing specialty care and coming from another state, they must have an approved referral.

Navigate/Charter

* No

Yes

* Network exclusive to Swedish/Providence. Virginia Mason is currently only contracted for hospital services. However, if the patient’s PCP will initiate a referral and Navigate/Charter will approve, referrals are accepted for specialty care. Note: if the services is available within their Navigate/Charter network, referral requests will NOT be approved by the plans.

AARP Medicare Complete Plus (HMO/POS)

Yes

No

* HMO - Referral for specialty care is required when one of the below primary care practices have been selected:
  • Highline Medical Services Organization,
  • Physicians Care Network,
  • NW Physicians Care Network, or
  • Everett Clinic Primary Care Provider.

If not under one of the above mentioned practices, approved specialty care referrals are not required.  However, some services may require prior-authorization.

* When prior-authorizing for the Medicare programs always use the UHCWest website.  Unless the Medicare program is Community Plan Dual Complete. If Community Plan Dual Complete, use UnitedHealthcareonline.

AARP Medicare Complete West - HMO

Yes

* Yes/No

Medicare Advantage PPO

Yes

No

* Community Plan Dual Complete – also called Evercare (HMO)

No

Yes

Contact your health insurance plan for information on covered services before your appointment.