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Non-Participating Care Provider Referrals (All Commercial Plans) - Chapter 5, 2019 UnitedHealthcare Administrative Guide

When services are not available, the members network physician can submit a request for an out-of-network review. You can submit a request by calling the number on the back of the member’s health care ID card.

We review the request and network providers available. If approved, we apply the network benefits to the services done by the out-of-network care provider. We mail our decision to the requesting care provider and the member.

We send a written confirmation with the final decision to the requesting care provider and the member.

Before Submitting a Request for Network Benefit Services From a Non-Participating Care Provider:

  1. See if there is a network care provider available by searching on the Physician Directory.
  2. If a network care provider is not available, see if the W500 icon appears on the back of the member’s health care ID card.
    a. If W500 is indicated, search for a network care provider in the W500 Emergent Wrap directory.
        I. If you find a W500 Emergent Wrap care provider, submit a request for coverage for the member to see that care provider.
    b. If W500 is not on the member’s health care ID card or you cannot find a network care provider in the W500 Emergent Wrap Directory, continue submitting your request.

To find a list of care providers participating in the W500 network, go to Find a Provider > Search for Care Providers in the General UnitedHealthcare Plan Directory > All UnitedHealthcare Plans > W500 Emergent Wrap.