Common Questions
If I choose to waive medical benefits, why do I need to submit proof of other coverage? Proof of coverage is requested to ensure a safe and healthy workplace. By providing this proof, you are telling us that you – like participants in Tishman's Employee Benefits Program – are protected medically when you experience health-related issues. If my spouse has coverage and I electcoverage as well, how will benefitsbe paid out? The benefits are paid according to what is known as Coordination of Benefits (COB). COB applies to the payment of health care benefits when a member is covered by two or more benefit plans. Here, Oxford pays the lesser of the member's unreimbursed, allowable expense or Oxford's normal liability. How it Works: Oxford would pay your claim as if there was no other insurance to consider. Then your spouse's plan would pay for any amounts your plan did not (assuming the amount can be tied to a covered benefit). When you receive care within the Oxford network, COB becomes limited based upon the low copay levels associated with in-network coverage. For example, if youvisit a Oxford specialist,youwill be required to pay a $15 or $40 (dependingon planelected) office visit copay out of pocket. If you are covered under your spouse's health plan, you can only request reimbursement for the $15 or $40 (depending on plan elected) copay you were responsible for under the Oxford Plan from your spouse's health plan. In this instance, maintaining medical coverage under two plans does not present a financial advantage.
Where can I search for participating Oxford behavioral health providers? You may search for participating Oxfordbehavioral health providers by logging on to www.liveandworkwell.com/public .
Do I need to pre-certify my hospital stay? If so, why? Yes. Hospital stays require precertification. Under the precertification program, experienced health professionals will check your physician's recommended course of treatment to ensure the care you receive is appropriate and cost-effective. In emergency situations, you should not worry about obtaining precertification before seeking treatment. However, you must report your emergency within 48 hours in order to ensure that your treatment is covered. What constitutes a true emergency? An "emergency" is defined as a serious accident or sudden illness that, if not treated immediately, could result in a long-term medical problem or loss of life. If several doctors form a group practice and one participates with Oxford, can I assume they all do? Not necessarily. Insurance contracts are issued to individual doctors, not groups. Therefore, if you are considering visiting a particular doctor, you should always contact the doctor's office before making an appointment to determine whether or not they accept your insurance. How do I obtain a list of UnitedHealthcare vision care providers? Participants may utilize UnitedHealthcare Vision's Internet Provider Locator 24 hours a day, 7 days a week to locate a convenient participating provider. Through the website, choose the provider locator option and click on the "current member" link. Enter the necessary information and search criteria and you will be supplied with a list of convenient providers to select from, including the distance in miles to that provider. Once a participating provider is chosen, call the provider directly to schedule an appointment. Participants may also call our 24-hour, toll-free number at 1-800-839-3242 for an automated list. Following the voice prompts, simply enter your Unique Identification Number (SSN) and your work or home ZIP code. The system will respond with a list of names, addresses and telephone numbers of conveniently located providers. How do I identify myself as a UnitedHealthcare vision plan participant? When contacting the provider to make your appointment, simply give the provider the participant's name, date of birth, the Unique Identification Number (SSN) of the primary subscriber and the employee name. Identify yourself as having UnitedHealthcare Vision coverage. An in-network provider will verify eligibility and receive authorization prior to your appointment.
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