Charging members for
non-covered services
For Commercial members, you may seek and collect payment from our member for
services not covered under the applicable benefit plan, provided you first
obtain the member’s written consent. Such consent must be signed and dated
by the member prior to rendering the specific service(s) in question. Retain a
copy of this consent in the member’s medical record. In those instances in
which you know or have reason to know that the service may not be covered
(as described below), the written consent also must: (a) include an estimate of
the charges for that service; (b) include a statement of reason for your
belief that the service may not be covered; and (c) in the case of a
determination by us that planned services are not covered services,
include a statement that UnitedHealthcare has determined that the service
is not covered and that the member, with knowledge of UnitedHealthcare’s
determination, agrees to be responsible for those charges.
For Medicare Advantage members, a Notice of Denial of Medical Coverage must be
provided to the member advising them when a service is not covered.
