UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) 查找工具

Prior Authorizations

Download the list of services that require prior authorizations. 

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, 08:00 to 17:00 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).

Appeal or Grievance

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

Prior Authorizations

Pharmacy Prior Authorization Request to OptumRx

Submit a Pharmacy Prior Authorization Request to OptumRx.

處方藥物 - Medicare D 部分不予承保

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 https://member.uhc.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.

牙科服務提供者搜尋

尋找您所在地區的牙醫師。點按下方「搜尋牙醫師」，即可開始進行您的搜尋。

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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. Our UM team is available Monday through Friday, 08:00 to 17:00 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).

Appeal or Grievance

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

尋找藥房

在下方搜尋一家 UnitedHealthcare 網路藥房。

藥房

This part of the directory provides a list of pharmacies in UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) 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 (Medicare-Medicaid Plan) 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 (Medicare-Medicaid Plan) 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 (Medicare-Medicaid Plan) 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 (Medicare-Medicaid Plan) 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, 08:00 - 20:00, local time, Monday - Friday. 此電話免費。

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 (Medicare-Medicaid Plan) 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, 08:00 - 20:00, local time, Monday - Friday.

Home Infusion Pharmacies
You can get home infusion therapy if UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) 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, 08:00 - 20:00, 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 (Medicare-Medicaid Plan) through the facility’s pharmacy or another network pharmacy.

For more information, you can call Member Services at 1-877-542-9236, TTY 711, 08:00 - 20:00, local time, Monday - Friday.

Prior Authorizations

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. Our UM team is available Monday through Friday, 08:00 to 17:00 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).

處方藥物轉換期間處理流程

您目前的處方藥物不在處方集上，或在處方集上有限制的因應方式。

新保戶
As a new member of UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan), 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.

在這類情況下，請先與您的醫師討論處方集上是否有適當的替代藥物。如果找不到適當的替代藥物，您或您的醫師可請求處方集例外許可。如果例外許可請求獲得核准，您將可在指定期間內取得該藥物。當您和您的醫師正在決定您應採取的行動，在您成為計劃保戶的前 90 天期間，您可能有資格隨時獲得該藥物的初次 31 天轉換期間供藥（除非您的處方單規定較少天數）。

針對您所需藥物不在處方集上或您取藥能力受限的每種藥物，UnitedHealthcare 將承保 31 天供藥（除非您的處方單規定較少天數），但您必須在網路藥房購藥。如果您的處方單規定少於 31 天，將允許多次再度取藥，直到達到 31 天的總供藥量為止。經過您初次 31 天轉換期間供藥期限後，這類藥物可能不持續獲得承保。請與您的醫師討論是否有適當的替代藥物。如果處方集上沒有適當的替代藥物，您或您的醫師可請求處方集例外許可。

如果您住在長期照護機構，UnitedHealthcare 將承保暫時性 31 天轉換期間供藥（除非您的處方單規定較少天數）。UnitedHealthcare 將為承保計劃保戶在前 90 天內再度取得這類藥物一次以上，直到達到 93 天供藥量為止。如果您需要的藥物不在處方集上，或您取藥的能力受限，但是您已過了成為計劃保戶後前 90 天期間，此轉換期間方案將在您申請處方集例外許可的期間，承保該藥物 31 天緊急供藥（除非您的處方單規定較少天數）。

在投保計劃後的前 90 天之後，您可能遇到非預期的轉換情況，例如出院或照護等級改變（意即在長期照護結束後的一週內）。如果您獲得開立的處方藥不在處方集上，或您取得藥物的能力受限，您必須利用本計劃的例外許可申請流程。您可申請多達 31 天的單次緊急供藥，讓您有時間與您的醫師討論替代治療方式，或申請處方集例外許可。

續保保戶
身為本計劃的續保保戶，您會收到一份年度變更通知 (ANOC)。您可能會發現您目前服用的處方集藥物不在隔年的處方集上，或隔年的藥物費用分攤或承保有限制。

針對每年在 12 月 15 日前收到並核准的藥物承保申請，本計劃將自 1 月 1 日起承保該藥物。針對在 12 月 16 日之後才提出的承保申請，將適用決議所需一般時間規定：緊急申請將在 24 小時內收到回覆，所有其他申請將在 72 小時內收到回覆。如果您的申請在 1 月 1 日當天仍在處理中，您將獲得依照您目前計劃費用分攤規定的暫時性供藥，直到您的申請獲得回覆。

如果您對於此轉換時期政策有任何疑問，或在處方集例外許可申請上需要協助，UnitedHealthcare 服務人員可給予協助。

相關資訊
The Coverage Determination Request Form may be found under Appeal a Coverage Decision section on this page.