UnitedHealthcare Community Plan Updates Several Therapy Policies
UnitedHealthcare Community plan has revised one clinical policy pertaining to cognitive rehabilitation, 3 coverage determination guidelines pertaining to outpatient physical, occupational and speech therapy services and 2 utilization review guidelines pertaining to outpatient physical, occupational and speech therapy services.
The following policies have been revised with an effective date of April 1, 2020 except for Cognitive Rehabilitation which became effective March 1, 2020:
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UHC has always been direct access for WI contracted providers- this policy contradicts that: “Treatment must be ordered by a physician”- is this their intent?
As I know you know, I can’t assume their intent. The policy does state this applies to the state of Wisconsin and Treatment must be ordered by a physician and be Medically Necessary for the member’s plan of care (POC). I would recommend you and others contact UHC based on this revised policy.
Is there a policy specific to SC? Also I noticed the “must be Medically necessary, including cost effective” clause which limits who can be seen in a outpatient hospital setting. I have never seen this type of clause before. Is becoming a standard practice by insurers? Do any other insurers have a similar policy?
You would want to check the UHC website.
Do the details of the policy apply to out of network providers?
My opinion, yes. I would recommend you contact UHC.
It seems that at least in FL this only applies to Medicaid plans “community plans” as stated.