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Medicare Advantage UnitedHealthcare

Please read the terms and conditions below carefully.

These UnitedHealthcare Coverage Summaries are applicable to UnitedHealthcare Medicare Advantage Plans offered by UnitedHealthcare and its own affiliates.

General Statements

  • Covered benefits, restrictions, and exclusions tend to be specified into the member's appropriate UnitedHealthcare Medicare proof of Coverage (EOC) and Summary of Advantages (SOB).
  • All solutions rendered should be referred and authorized because of the user's supplier, unless particularly claimed otherwise in EOC or SOB.
  • UnitedHealthcare abides by Center of Medicare and Medicaid Services (CMS) repayment policies, and National Coverage Determinations (NCDs).
  • When you look at the lack of an NCD, UnitedHealthcare abides by relevant regional Coverage Determinations (LCDs). LCDs tend to be specific written guidelines created by the Medicare Administrative Contractor (MAC) with jurisdiction for each individual State. Where services tend to be included in UnitedHealthcare in an area that features jurisdictions in excess of one specialist for initial Medicare, therefore the contractors have different health review guidelines, UnitedHealthcare must apply the health analysis guidelines for the contractor in the region where in fact the beneficiary everyday lives.
  • Into the lack of an appropriate NCD, LCD, or any other CMS published guidance, UnitedHealthcare develops and preserves medical policies that describe the Typically Accepted requirements of Medical Practice systematic evidence, prevailing health criteria and medical tips promoting our determinations regarding specific solutions ("UnitedHealthcare Medical Policies"). Usually Accepted requirements of Medical application are standards being centered on reputable medical research posted in peer-reviewed health literary works typically acknowledged by the relevant health neighborhood, depending mostly on controlled medical trials, or, or even available, observational researches from one or more institution that suggest a causal relationship amongst the service or therapy and wellness outcomes.

The Coverage Summaries are guidelines according to existing present Medicare National Coverage Determinations, regional Coverage Determinations, UnitedHealthcare healthcare Policies, and appropriate UnitedHealthcare Medicare positive aspect Plans EOCs and SOBs meant to supply advantage coverage information and recommendations certain to UnitedHealthcare Medicare positive aspect Plans. The Coverage Summaries are developed and reviewed by the UnitedHealthcare Medicare Benefit Interpretation Committee. Benefit interpretations for UnitedHealthcare Medicare positive aspect Plan Members are built on a case-by-case basis using the guidelines in Coverage Summaries. The Coverage Summaries...

Source: www.unitedhealthcareonline.com
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