Hla mus rau cov ntsiab lus xub thawj
Cov Ntsiab Lus Xub Thawj

UnitedHealthcare Community Plan Ntsiab Lus Tshab Txhais

A

  • Kev Tsim Txom

    Causing harm to a person on purpose. This includes yelling, ignoring a person's need, hurting or inappropriate touching.

  • Kev thov kev ncaj ncees

    Ib daim ntawv thov los tshuaj xyuas ib qhov hauj lwm uas tau ua thaum koj tsis txaus siab rau ib qhov kev txiav txim siab los ntawm koj daim phiaj npaj kho mob.

C

  • Qhov Nyiaj Tuav Pov Hwm Uas Yus Nrog Them (Coinsurance)

    Ib feem pua ntawm qhov nqi kho mob uas koj yuav tsum them rau tus kws kho mob rau qhov kev kho mob ntawd.

  • Copayment

    Copayments (copays) are a dollar amount that you pay to the doctor at your visit.

D

  • Qhov Nyiaj Yus Them Ua Ntej (Deductible)

    The annual deductible is the total amount of money you must pay for some services that require coinsurance over the eligibility year.  You must pay the annual deductible before UnitedHealthcare will cover services that have coinsurance. 

E

  • Kev kub ntxhov

    A situation where your health, or the health of an unborn baby, could be threatened. Medical help is needed right away.

G

  • Kev tsis txaus siab

    Koj cov lus tsis txaus siab rau ib feem twg ntawm koj txoj kev saib xyuas kho mob. Kev tsis txaus siab tuaj yeem ua tau hauv xov tooj los sis sau ntawv, thiab yuav tsum xa ncaj qha mus rau koj daim phiaj.

I

  • Immunization

    A shot that protects from a disease.

  • In-Network

    Doctors, specialists, hospitals, pharmacies and other providers who have an arrangement to provide health care services to members.

  • Income Band

    Identification of a group of members based on income and poverty level.

L

  • Living Will

    A document that tells what you want done with your health care. The doctor uses this if you are not able to express what you want. It lists specific treatments you do or do not want, and whether or not to make special efforts to save your life.

M

  • Medically Necessary

    Services that are required to maintain your health and by not receiving those services, could affect your condition or quality of care.

  • Tswv cuab

    Ib tus neeg muaj feem tau txais rau npe rau hauv daim phiaj UnitedHealthcare Health Plan.

O

  • Out-of-Network

    Doctors, specialists, hospitals, pharmacies and other providers who do not have an arrangement with your plan to provide health care services.

P

  • Nyiaj Them (Premium)

    A monthly fee that you pay to stay enrolled in UnitedHealthcare.

  • Prescription

    A doctor's written instructions for medication or treatment.

  • Tus Kws Kho Mob Xub Thawj (PCP)

    The doctor who treats you for all normal health care needs. Your PCP may refer you to a specialist or admit you to a hospital. PCPs are usually family practitioners, internists, pediatricians, and sometimes nurse practitioners and physician's assistants, and can include Obstetricians and certified nurse midwives for pregnant members.

  • Prior Authorization

    The process of reviewing a request for services to make sure it is a necessary service or plan of treatment and providing approval for those services before you receive them.

  • Kws Pab Kho Mob

    A person or facility that provides health care services and treatment such as a doctor, pharmacy, dentist, clinic or hospital.

R

  • Kev Xa Mus

    Process when your primary care provider requests additional care for you from a specialist.

S

  • Second Medical Opinion

    A review of a medical condition that is done by another doctor.

  • Kws Kho Mob Tshwj Xeeb

    Any doctor who has special training for a specific condition or illness.

Rov qab mus rau sab saum toj ntawm nplooj ntawv


New York State sponsored health insurance programs.
(swb txav hauv lub npov no txhawm rau saib)

To learn more about applying for health insurance, including Medicaid, Child Health Plus, Essential Plan, and Qualified Health Plans through NY State of Health, The Official Health Plan Marketplace, visit nystateofhealth.ny.gov or call 1-855-355-5777. To find out if you qualify for Medicaid Managed Care or Child Health Plus offered by UnitedHealthcare Community Plan, please call 1-888-617-8979. UnitedHealthcare does not discriminate on the basis of race, color, national origin, sex, age or disability in health programs and activities. We provide free services to help you communicate with us. Such as, letters in other languages or large print. Or, you can ask for an interpreter. To ask for help, please call Member Services at 1-800-493-4647, TTY 711, 8 AM – 6 PM, Monday – Friday ATTENTION: Language assistance services, free of charge, are available to you. Call 1-800-493-4647, TTY 711. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-493-4647, TTY 711. 注意：您可以免費獲得語言援助服務。請致電 1-800-493-4647, TTY 711 ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-800-493-4647 (телетайп: TTY 711).

Tau Hloov Tshiab Zaum Kawg Nkaus: 04.18.2024 at 12:11 AM CDT

Cov ntaub ntawv qhia kev tsis lees txais kev thaj tsob
(swb txav hauv lub npov no txhawm rau saib)

Puas yog tab tom nrhiav lub vev xaib (website) Medicaid ntawm tsoom foov teb chaws? Saib tau nyob rau ntawm no Medicaid.gov.

UnitedHealthcare cov phiaj xwm Dual Complete

Cov phiaj xwm kho mob yog them los ntawm Lub Tuam Txhab Muab Is Saws Las Tuav Pov Hwm UnitedHealthcare los sis ib lub ntawm cov tuam txhab tau koom lag luam ua ke, ib lub koom txoos Medicare Advantage uas muaj Medicare daim ntawv cog lus ua hauj lwm ua ke thiab ib daim ntawv cog lus nrog lub Xeev Lub Khoos Kas Medicaid. Qhov yuav rau npe rau hauv qhov phiaj xwm kho mob yog nyob ntawm seb daim phiaj xwm kho mob daim ntawv sib cog lus tshiab nrog Medicare hais li cas. Daim phiaj xwm kho mob no muaj rau txhua tus neeg uas muaj ntawv pab kho mob Medical Assistance tuaj tim Xeev thiab tuaj tim Medicare tuaj tib si. Cov nyiaj pab, cov xim xoo zoo tshwj xeeb thiab/los sis cov cuab yeej koos pis tawj yuav sib txawv mus raws qhov phiaj xwm kev npaj tuav pov hwm kev kho mob/cheeb tsam. Tej zaum yuav tau siv cov ciaj ciam, cov kev cais tawm thiab/los sis cov kev txwv ntawm pab pawg kho mob koom tes ua ke. Cov kev pab, cov nqi them tus nqi tuav pov hwm thiab/los sis cov nqi feem nrog them/koom them kev tuav pov hwm tej zaum yuav muaj pauv thaum Lub Ib Hlis tim 1 txhua xyoo.

Daim ntawv tsis lees paub txog qhov nyiaj pov hwm kev kho mob

Cov phiaj xwm kev npaj tuav pov hwm kev kho mob uas Xav Tau Kev Pab Tshwj Xeeb Ob Yam Tib Si muab ib qho nyiaj pov hwm kev kho mob $0 rau cov tswv cuab uas xav tau Kev Pab Tshwj Xeeb (Nyiaj Pab Rau Cov Uas Khwv Tau Nyiaj Los Tsawg).

Daim ntawv tsis lees paub txog qhov nyiaj pab them nqi

Cov nyiaj pab them nqi, cov yeeb yam, thiab/los sis cov cuab yeej yuav sib txawv raws daim phiaj/cheeb tsam. Tej zaum yuav tau siv cov ciaj ciam, cov kev cais tawm thiab/los sis cov kev txwv ntawm pab pawg kho mob koom tes ua ke.

Kev tsis kam lees txoj kev thaj tsob Tus Xov Tooj Maj Rawm Ntawm Tus Kws Tu Neeg Mob

Qhov kev pab no yuav tsum tsis txhob muab siv rau cov kev xav tau ntawm kev mob xwm txheej ceev los sis maj rawm. Yog tias yog xwm txheej ceev, hu rau 911 los sis mus rau ntawm ib chav kho mob xwm txheej ceev nyob ze ntawm koj tshaj plaws. Cov ntaub ntawv tau muab los nyob rau qhov kev pab cuam no tsuas yog siv rau lub hom phiaj ua kev paub xwb. Cov kws tu neeg mob tsis muaj peev xwm kuaj pom cov teeb meem los sis xav kom yuav tsum mus kho mob thiab lawv tsis yog ib qho kev sib hloov pauv rau koj tus kws muab kev saib xyuas kho mob qhov kev saib xyuas kho mob. Koj cov ntaub ntawv kho mob yuav raug muab kaw cia tsis pub lwm tus paub raws nraim li txoj cai lij choj. Qhov kev pab cuam tsis yog ib qho txheej txheem pab cuam ntsig txog is saws laws tuav pov hwm thiab tej zaum yuav raug txiav tawm thaum twg los tau. Tus Xov Tooj Hu Maj Ceev Rau Tus Kws Tu Xyuas Neeg Mob (Nurse Hotline) tsis yog siv rau thaum muaj xwm txheej kub ceev, tsuas yog siv rau lub hom phiaj hu qhia cov ntaub ntawv kaus xwb.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan)

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan) yog ib qhov phiaj xwm kho mob uas tau cog lus nrog Medicare thiab Ohio Medicaid tib sid kom muab cov kev pab ntawm ob qhov khoos kas pab cuam rau cov neeg rau npe txais kev pab. 

UnitedHealthcare Connected® (Medicare-Medicaid plan)

UnitedHealthcare Connected® (Medicare-Medicaid txoj phiaj xwm) yog ib qhov phiaj xwm kho mob uas tau cog lus nrog Medicare thiab Texas Medicaid ob yam tib si kom muab cov kev pab ntawm ob qhov khoos kas pab cuam rau cov neeg rau npe txais kev pab.

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan)

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan) yog ib qhov phiaj xwm kho mob uas tau cog lus nrog Medicare thiab MassHealth (Medicaid) tib sid kom muab cov kev pab ntawm ob qhov khoos kas pab cuam rau cov neeg rau npe txais kev pab. 

UnitedHealthcare Connected® cov lus hais txog kev pab

Qhov nod tsis yog daim ntawv teev npe uas muaj txhij txhua. Cov lus qhia txog cov kev pab yog ib qhov lus xaus tseem ntsiab luv luv xwb, nws tsis yog piav txhij txhua txog cov kev pab. Yog xav paub cov ntaub ntawv qhia paub ntau ntxiv ces tiv tauj mus rau qhov phiaj xwm kho mob los sis nyeem phau ntawv qhia tswv cuab. Tej zaum nws yuav muaj cov kev txwv, cov nyiaj sib koom them, thiab cov kev tsis pub ua tshaj. Yog xav paub ntxiv, hu rau UnitedHealthcare Connected® Lub Chaw Pab Cuam Tswv Cuab los sis nyeem UnitedHealthcare Connected® phau ntawv qhia tswv cuab. 

UnitedHealthcare Senior Care Options (HMO SNP) txoj phiaj xwm

UnitedHealthcare Senior Care Options (SCO) yog ib qho phiaj xwm kho mob uas Tau Koom Tes Ua Ke Saib Xyuas Kho Mob uas muaj daim ntawv cog lus nrog Medicare thiab daim ntawv cog lus nrog rau qhov txheej txheem pab cuam Commonwealth of Massachusetts Medicaid. Qhov yuav rau npe rau hauv qhov phiaj xwm kho mob yog nyob ntawm seb daim phiaj xwm kho mob daim ntawv sib cog lus tshiab nrog Medicare hais li cas. Qhov phiaj xwm kho mob no yog ib qho txheej txheem pab cuam pub dawb raws siab yeem uas muaj rau txhua leej uas muaj hnub nyoog 65 xyoo thiab cov neeg laus dua uas tsim nyog rau MassHealth Standard thiab Original Medicare thiab tsis muaj lwm yam Is Saws Las Tuav Pov Hwm Kho Mob uas muaj tag nrho txhua yam kev kho mob nyob rau hauv, tshwj kiag Medicare. Yog tias koj muaj MassHealth Standard, tab sis koj tsis tsim nyog rau Original Medicare, tej zaum koj tseem muaj cai tso npe rau hauv peb qhov phiaj xwm kho mob MassHealth Senior Care Option thiab tau txais tag nrho koj cov kev pab MassHealth los ntawm peb qhov txheej txheem pab cuam Senior Care Options (SCO).

Kev tsi kam lees kev muab qhab nias hnub qub

Txhua-Txhua Xyoo, Medicare ntsuam xyuas cov phiaj xwm kho mob raws kev muab qhab nias 5-Lub Hnub Qub. Qhov kev ntaus nqi muab 5-Lub Hnub Qub siv tau rau daim phiaj kho mob hauv lub xyoo 2024.

Cov ntaub ntawv tseem ceeb hais txog tus kws kho mob

Txoj kev xaiv yog koj li

Peb yuav muab cov ntaub ntawv qhia rau koj txhawm rau pab koj txiav txim siab los xaiv, xws li cov ntaub ntawv pov thawj txheeb txog cov kws kho mob thiab cov kws kho mob txawj tshaj lij. Txawm li cas los xij, cov ntaub ntawv qhia no, tsis yog kev pom zoo los ntawm ib tus kws kho mob los sis kws kho mob txawj tshaj lij qhov kev tsim nyog rau koj cov kev xav tau.

Cov kws muab kev pab kho mob uas muaj los ntawm daim ntawv thov no yuav tsis tas cuam tshuam txog tag nrho ntawm UnitedHealthcare lub network ntawm cov kws muab kev pab kho mob uas tau cog lus. Tej zaum yuav muaj cov kws muab kev pab kho mob los sis qee yam kev txawj tshwj xeeb uas tsis suav nrog hauv daim ntawv thov no uas yog ib feem ntawm peb lub network. Yog hais tias koj tsis pom tus kws muab kev pab kho mob uas koj tab tom nrhiav, koj tuaj yeem tiv tauj ncaj nqa mus rau tus kws muab kev pab kho mob txhawm rau txheeb xyuas qhov kev koom tes nrog UnitedHealthcare lub network, los sis tiv tauj rau Feem Saib Xyuas Cov Neeg Qhua ntawm tus naj npawb xov tooj hu dawb uas muaj nyob hauv koj daim npav ID UnitedHealthcare. Dua li nod lawm peb kuj tseem qhia tias, ua ntej yuav mus ntsib ib tus kws kho mob twg, suav nrog cov kws kho mob txawj tshwj xeeb, koj hu rau tus kws kho mob lub chaw ua hauj lwm txhawm rau txheeb xyuas lawv qhov kev koom tes thiab kev npaj muaj.

Qee cov neeg muab kev pab kho mob hauv lub network yuav raug ntxiv los sis tshem tawm ntawm peb lub network tom qab cov npe no tau hloov kho. Peb tsis lav tau tias txhua tus kws muab kev pab kho mob tseem yuav txais cov tswv cuab tshiab ntxiv.

Cov kws muab kev pab kho mob uas tsis nyob hauv pab pawg kho mob koom tes ua ke/tsis muaj-ntawv cog lus yog tsis muaj kev sib cuam tshuam txog qhov kho cov tswv cuab nyob ntawm lub phiaj xwm UnitedHealthcare, tsis xam nrog thaum muaj xwm txheej ceev. Thov hu rau tus nab npawb pab cuam tub lag luam los sis mus saib koj li Pov Thawj ntawm Kev Pab Them Rau rau kev paub ntxiv, xam nrog rau tus nqi- sib faib them uas yuav siv rau cov kev pab cuam nyob sab nraud-ntawm nev vawj.

Daim ntawv ceeb toom Ntawm Tsab Cai Hais Txog Cov Neeg Meskas Uas Muaj Mob Xiam Oob Khab

Raws li cov kev cai ntawm tsoom fwv teb chaws tsab cai Americans with Disabilities Act ntawm 1990 thiab Tshooj lus 504 ntawm tsab cai Rehabilitation Act ntawm 1973 ("ADA"), UnitedHealthcare Lib Tuam Txhab Muab Is Saws Las Tuav Pov Hwm muab cov kev nkag cuag tau cov kev pab them nqi kho mob tag nrho thiab sib npaug thiab tsis pub muaj kev ntxub ntxaug rau cov tib neeg uas muaj qhov kev tsis taus raws li lub hauv paus ntawm kev tsis taus nyob rau hauv nws cov kev pab cuam, cov khoos kas pab, los yog tej kev ua dej num.

Cov ntawv xa mus rau lwm qhov

Cov kws muab kev kho mob koom hauj lwm ua ke yuav pab tau koj thiab cov neeg hauv koj tsev uas muaj npe kom tau txais qhov kev pab kho tus mob uas xav tau. Kev nkag mus cuag tau rau cov kws kho mob txawj tshwj xeeb tej zaum yuav tau txais kev koom tes los ntawm koj tus kws kho mob xub thawj.

Daim ntawv thov daim ntawv teev cov npe

Cov ntawv theej ntawm cov npe kws muab kev pab kho mob hauv network muaj rau cov tswv cuab yam tsis tau them nqi los ntawm kev hu rau tus xov tooj feem pab cuam cov neeg qhua uas nyob nraum qab ntawm koj daim npav ID. Cov neeg uas tsis yog cov tswv cuab tuaj yeem rub tawm thiab luam tawm cov txiaj ntsig tshawb fawb los ntawm cov npe hauv online.

Cov ntaub ntawv uas tsis raug

Yog xav tshaj tawm qhia cov ntaub ntawv uas tsis raug, xa email provider_directory_invalid_issues@uhc.com. Lub npov (box) sau email no yog muab rau cov tswv cuab qhia paub txog cov ntaub ntawv uas sau tsis yog lawm (xws li qhov chaw nyob, tus xov tooj, thiab lwm yam) cov ntaub ntawv qhia nyob hauv online los yog nyob hauv cov ntawv teev npe. Kev qhia cov teeb meem siv lub npov sau ntawv li no yuav ua rau xa mus txog tus kws kho mob qhov chaw ua hauj lwm kom xyuas cov ntaub ntawv uas muab tso rau hauv daim ntawv teev npe, uas tuaj yeem siv sij hawm kwv yees li 30 hnub. Sawv daws kuj tseem siv tau lub xov tooj hu qhia paub txog tej yam sau tsis yog li no thiab. UnitedHealthcare Cov Tswv Cuab yuav tsum hu rau tus xov tooj uas muaj nyob sab nraum qab ntawm lawv daim npav ID, thiab cov uas tsis yog UnitedHealthcare cov tswv cuab tuaj yeem hu rau 1-888-638-6613 / TTY 711, los sis siv qhov kev pab hu rau cov neeg tsis hnov lus zoo uas koj nyiam.

Tshaj tawm txog kev puas tsuaj los sis xwm txheej kub ceev

Yog tias koj raug cuam tshuam los ntawm kev puas tsuaj los sis kev tshaj tawm xwm txheej ceev los ntawm Thawj Tswj Hwm los sis tus thawj kav teb chaws, los sis tshaj tawm txog kev kub ntxhov rau pej xeem kev noj qab haus huv los ntawm Tus Thawj Saib Xyuas Kev Noj Qab Haus Huv thiab Cov Kev Pab Cuam Tib Neeg, muaj qee yam kev txhawb nqa ntxiv rau koj.

  • Tshooj A, Tshooj B, thiab cov nyiaj pab ntxiv ntawm txoj phiaj xwm rau Tshooj C yuav tsum tau muab rau ntawm cov chaw kho mob tsis muaj-ntawv cog lus (nco ntsoov tias Tshooj A thiab Tshooj B cov txiaj ntsig pab yuav tsum tau txais cov txiaj ntsig ntawm Medicare cov chaw kho mob muaj ntawv ua pov thawj);
  • Yog tias tsim nyog, cov cai hais txog ntawm tus neeg saib xyuas qhov rooj muaj ntaub ntawv ua pov thawj ces raug zam tag nrho;
  • Kev sib koom them nqi kho mob uas tsis nyob hauv pab pawg koom tes ua ke uas tau txais kev pom zoo raws li qhov phiaj xwm kev npaj mus rau cov nqi sib koom them hauv pab pawg koom tes ua ke yuav raug txo qis mus ib ntus; thiab
  • Yog tias txhua yam hloov pauv tag nrho (xws li txo tus nqi sib faib them thiab kev tso cai zam) muaj txiaj ntsig rau cov tswv cuab, yog li ntawd qhov kev ceeb toom 30-hnub yuav tsum tau zam rau cov tswv cuab.

Cov phiaj xwm yuav rov ua hauj lwm li qub 30 hnub tom qab tau tshaj tawm thawj zaug, yog tias CMS tsis tau muab hnub kawg rau kev puas tsuaj los sis xwm txheej ceev.

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