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UnitedHealthcare Connected® for One Care (Medicare-Medicaid Plan) Lookup Tools
Nrhiav ib Tug Kws Kho Mob
Nrhiav Ib Tus Kws Kho Mob
Upon enrollment, the Plan will help you choose a Primary Care Provider (PCP). Our Member Engagement Center can assist you in the selection of a new PCP whenever necessary. If there is a particular specialist or hospital that you want to use, check first to see if they are in our network of providers.
Search our directory of network physicians and facilities.
2024 Provider/Pharmacy Directories
Nrhiav Ib Yam Tshuaj
2024 Formularies
Tus Txheej Txheem Kev Hloov Cov Tshuaj Kws Kho Mob Sau Ntawv Yuav (Prescription Drug Transition Process)
Yuav ua li cas yog hais tias koj cov tshuaj uas kws kho mob sau ntawv yuav tam sim no tsis muaj nyob ntawm Daim Ntawv Teev Npe Tshuaj (formulary) los yog muaj kev txwv ib qhov twg
Cov tshuaj tsis nyob ntawm daim ntawv teev npe hauv nqe lus
Muaj tej thaum, koj kuj yuav tau noj ib qho tshuaj uas tsis nyob hauv daim phiaj Daim Ntawv Teev Npe Tshuaj los yog muaj kev txwv ib qhov twg. Txawm koj yuav yog ib tus tswv cuab tshiab los yog ib tus tswv cuab qub ua ntu zus los mus, nws muaj ib txoj kev nrhiav kom tau kev pab.
Pib los ntawm qhov tham nrog koj tus kws kho mob. Koj tus kws kho mob tuaj yeem pab txiav txim seb puas muaj lwm yam tshuaj nyob ntawm Daim Ntawv Teev Npe Tshuaj uas koj tuaj yeem hloov tau. Yog hais tias tsis muaj lwm yam tshuaj zoo, koj, koj tus neeg sawv cev los yog koj tus kws kho mob tuaj yeem thov tau kom muaj kev zam. Yog qhov zam rau koj ntawd tau pom zoo muab, koj tuaj yeem tau txais koj qhov tshuaj tam sim no mus ib lub sij hawm.
Mus saib koj daim Ntawv Pov Thawj ntawm Qhov Pab Them Rau (Evidence of Coverage, EOC) kom paub seb koj daim phiaj them rau dab tsi kiag. Yog hais tias koj tseem yog ib tus tswv cuab ua ntu zus los mus, koj yuav tau txais ib Daim Ntawv Ceeb Toom Txog Kev Hloov Pauv Txhua Xyoos (Annual Notice of Changes, ANOC). Mus saib koj daim ntawv ceeb toom kom zoo kom paub seb koj cov tshuaj tam sim no puas them rau ib li qub hauv lub xyoos tom ntej.
Txawm koj yuav hloov mus rau cov tshuaj tshiab los yog nyob tos kom pom zoo rau qhov koj tau thov ntawd, tej zaum koj yuav muaj feem tau txais koj qhov tshuaj tam sim no mus ntxiv.
- Koj yuav tsum tau txais qhov tshuaj kom txaus noj 1 lub hlis, raws li piav hauv daim ntawv EOC, thaum thawj 90 hnub ntawm kev ua tswv cuab hauv daim phiaj li yog ib tus tswv cuab tshiab LOS YOG hauv thawj 90 hnub ntawm lub xyoos (calendar year) yog hais tias koj yog ib tus tswv cuab qub ua ntu zus los mus thiab koj qhov tshuaj nyob rau qhov muaj hloov pauv tsis muaj tshuaj txaus.
- Tej zaum koj kuj yuav muaj feem tau txais qhov tshuaj ib zaug, txaus noj 1 hlis mus ib ntus yog hais koj muaj cai rau ib qho nqa tshuaj xwm txheej kub ceev thaum nyob hauv ib qhov chaw pab tu mus sij hawm ntev (LTC) tom qab thawj 90 hnub li yog ib tus tswv cuab tshiab los yog koj los nyob rau theem hloov pauv kev tu xyuas koj.
- Yog koj tus kws kho mob sau tshuaj rau koj tsawg hnub dua thiab koj qhov tshuaj muaj qhov mus nqa tau ntxiv, koj yuav mus nqa tau qhov tshuaj ntxiv kom txog rau thaum koj tau txais qhov tshuaj txaus noj 1 hlis, raws li piav hauv koj daim ntawv EOC.
Cov Tus Tswv Cuab Tshiab
Thaum yog ib tus tswv cuab tshiab hauv daim phiaj, tej zaum tam sim no koj yuav noj ib cov tshuaj uas tsis muaj nyob ntawm daim phiaj cov npe tshuaj (drug list), los yog yeej muaj tab sis muaj kev txwv ib qhov twg.
Yog thaum zoo li no, xub tham nrog koj tus kws kho mob txog lwm yam tshuaj uas siv tau ib yam uas muaj nyob ntawm cov npe tshuaj. Yog hais tias ho tsis muaj lwm yam tshuaj, koj los yog koj tus kws kho mob yuav thov tau kom muab kev zam. Yog hais tias pom zoo muab kev zam rau koj, tej zaum koj yuav tau qhov tshuaj mus ib lub sij hawm tshwj xeeb.
Thaum lub sij hawm thawj 90 hnub ntawm koj kev ua tswv cuab rau hauv koj daim phiaj yog hais tias koj yog tswv cuab tshiab, koj yuav thov tau kom qhov tshuaj txaus noj 1 hlis, raws li piav hauv koj daim phiaj daim Ntawv Pov Thawj ntawm Qhov Pab Them Rau.
Thaum lub sij hawm thawj 90 hnuib ntawm lub xyoos (calendar year) yog hais tias koj twb nyob hauv daim phiaj xyoo dhau los no thiab koj qhov tshuaj nyob rau qhov muaj hloov pauv tsis muaj tshuaj txaus, koj tuaj yeem thov tau kom qhov tshuaj txaus noj tsawg kawg 1 hlis, raws li piav hauv koj daim phiaj daim Ntawv Pov Thawj ntawm Qhov Pab Them Rau.
Cov tswv cuab muaj cov kev hloov pauv uas tsis tau npaj ua ntej xws li kev tso tawm hauv tsev kho mob los mus tsev (suav nrog cov tsev kho mob ntsig txog kev mob puas hlwb los yog them kev tu xyuas hloov pauv (xws li, hloov cov chaw tu xyuas mus sij hawm ntev, tawm thiab nkag mus nyob rau hauv ib qhov chaw tu xyuas mus sij hawm ntev, tas kev pab them nqi hauv Part A hauv ib qhov chaw muaj kws tus mob pab tu, los yog tas kev pab them nqi hauv ib qhov chaw muaj mob zoo tsis taus thiab rov qab mus rau Medicare qhov pab them rau) tsis hais lub sij hawm twg hauv lub xyoos ntawm daim phiaj. Koj tuaj yeem thov tau kom qhov tshuaj txaus noj tsawg kawg 1 hlis, raws li piav hauv koj daim phiaj daim Ntawv Pov Thawj ntawm Qhov Pab Them Rau.
Cov uas ua tswv cuab mus txuas ntxiv
Tam li yog ib tus ua tswv cuab mus txuas ntxiv hauv koj daim phiaj, koj yuav tau txais ib Daim Ntawv Ceeb Toom Txog Kev Hloov Pauv Txhua Xyoos (Annual Notice of Changes, ANOC). Koj yuav pom tias ib qho tshuaj uas koj tseem tab tom noj tsis muaj nyob hauv cov npe tshuaj rau xyoo tom ntej los yog yeej muaj tab sis muaj kev txwv ib qhov twg hauv xyoo tom ntej.
Pib txij lub October 15, 2023, tej zaum koj yuav thov tau kom muaj ib qho kev tshuaj xyuas qhov kev pab them nqi rau koj hauv xyoo 2024 tau. Yog hais tias qhov koj thov ntawd tau txais kev pom zoo muab rau koj, koj daim phiaj xwm tuav pov hwm yuav them rau qhov tshuaj txij lub January 01, 2024.
Yog hais tias koj qhov tshuaj muaj cov kev txwv raws li tus qauv tshuaj tshiab rau ntawm lub January 01, 2024 thiab koj tsis tau sib tham nrog koj tus kws kho mob txog qhov hloov mus rau lwm yam tshuaj los sis thov kom zam ib qho tshuaj uas tsis nyob hauv cov npe tshuaj, koj yuav tau txais ib qho khoom siv kho mob mus ib ntus hauv thawj 90 hnub ntawm lub xyoo tshiab thaum koj mus rau ib lub khw muag tshuaj nyob hauv pab pawg kho mob koom tes ua ke. Qhov no yuav yog muab tshuaj txaus siv 1 hlis, raws li tau muab piav rau hauv koj daim phiaj qhov Pov Thawj ntawm Qhov Pab Them Rau, kom koj tau sij hawm los mus sib tham txog lwm txoj kev kho nrog koj tus kws kho mob los yog thov kom zam ib qho tshuaj uas tsis nyob hauv cov npe tshuaj.
Yog hais tias koj nyob hauv ib qhov chaw tu neeg mob mus sij hawm ntev, koj yuav mus nqa tau ntau zaus kom txog rau thaum koj nqa puv txog qhov tsawg kawg txaus noj 31 hnub, suav nrog rau qhov thaum twg yog thaum muab cov tshuaj tsawg dua qhov sau cia vim los ntawm txoj kev siv tshuaj uas yog muab raws li qhov sau rau ntawm daim ntawv lo.
Tej zaum kuj yuav muaj tej yam tsis tau npaj ua ntej xws li tsev kho mob tso tawm los yog theem kev kho mob hloov pauv (piv txwv li, hloov qhov chaw tu neeg mob mus sij hawm ntev los yog hauv lub lim tiam ua ntej los yog tom qab tawm hauv qhov chaw tu neeg mob mus sij hawm ntev, tas qhov nyob hauv qhov chaw tu neeg mob (skilled nursing facility) thiab hloov rov mus rau Medicare Part D kev pab them los yog muab rho tawm ntawm qhov kev tu nyob tos tas txoj sia (hospice care) uas yuav tshwm sim tau tsis hais lub sij hawm twg. Yog hais tias koj tau txais cov tshuaj uas kws kho mob tau sau daim ntawv yuav uas tsis nyob hauv peb Daim Npe Yeeb Tshuaj los sis koj muaj peev xwm mus txais koj qhov tshuaj uas muaj ciam txwv, koj yuav tau siv lub phiaj xwm kev lis ntaub ntawv uas tsis xam rau. Rau cov tshuaj feem ntau, tej zaum koj yuav thov tau ib zaug kom muab tshuaj txaus siv tsawg kawg ib lub hlis, raws li tau muab piav rau hauv koj daim phiaj qhov Pov Thawj ntawm Qhov Pab Them Rau, kom koj tau sij hawm los mus sib tham txog lwm txoj kev kho nrog koj tus kws kho mob los yog thov kom zam ib qho tshuaj uas tsis nyob hauv cov npe tshuaj.
Rau cov tswv cuab uas tau nyob hauv daim phiaj los tau ntau tshaj 90 hnub thiab nyob hauv ib qhov chaw pab tu mus sij hawm ntev (LTC) thiab xav tau ib qhov tshuaj tam sid, peb yuav them rau qhov tshuaj kom txaus noj tsawg kawg 31 hnub mus ib ntus, raws li piav hauv koj daim phiaj daim Ntawv Pov Thawj ntawm Qhov Pab Them Rau.
Yog hais tias koj muaj lus nug txog tsab cai siv rau qhov kev hloov no los yog xav tau kev pab thov kom zam ib qho tshuaj uas tsis muaj nyob hauv cov npe tshuaj, hu rau qhov chaw pab cov tswv cuab tus neeg sawv cev.
Yog xav tau cov ntaub ntawv hais txog tus txheej txheem hloov tshuaj uas kws kho mob sau ntawv yuav ua lus Spanish, mus rau ntawm Forms and Resources thiab saib nqe lus 5.2 ntawm koj qhov Pov Thawj ntawm Qhov Pab Them Rau (Evidence of Coverage) (Spanish) kom paub ntxiv.
Yog koj qhov tshuaj tas lawm tom qab tau txais ib qhov tshuaj noj mus ib ntus thiab koj tseem tab tom ua hauj lwm nrog koj tus kws kho mob sau tshuaj los mus hloov rau ib yam tshuaj los yog thov kom zam, hu rau tus xov tooj nyob ntawm koj daim npav ID ua tswv cuab los yog hu rau UnitedHealthcare Qhov Chaw Pab Cov Tswv Cuab
Lwm Yam Ntaub Ntawv Ntsig Txog Qhov No
Daim Ntawv Foos Thov Kev Txiav Txim Siab Them Rau (Coverage Determination Request Form) yuav nrhiav tau hauv nqe lus Thov Kom Muab Qhov Kev Txiav Txim Siab Them Rau Los Hais Dua (Appeal a Coverage Decision) nyob ntawm phab ntawv no.
Kev Tswj Hwm Muab Tshuaj Kho Mob (Medication Therapy Management Program)
UnitedHealthcare qhov Kev Tswj Hwm Muab Tshuaj Kho Mob (Medication Therapy Management (MTM)) yog tsim los ntawm ib pawg ntawm cov kws muab tshuaj thiab cov kws kho mob. Qhov kev pab MTM muab ib qho nrog xyuas kev siv tshuaj (comprehensive medical review (CMR)) rau cov tswv cuab nrog ib tus kws muag tshuaj los yog lwm tus kws muab kev kho mob uas tsim nyog. Qhov kev pab no pab cov tswv cuab kom nkag siab qhov kev pab them nqi thiab yuav siv lawv cov tshuaj li cas, thiab kuj tseem qhia rau cov tswv cuab kom paub tej kev phom sij uas yuav muaj tau thiab/los yog lwm yam uas yuav muaj cov kev pheej hmoo tshwm sim los ntawm cov tshuaj.
Yuav Ua Li Cas Thiaj Muaj Cai Tau Txais
Yam Uas Koj Yuav Tau Ua Yog Dab Tsi
Muaj Dab Tsi Ntxiv Tom Ntej
Yuav Ua Li Cas Thiaj Muaj Cai Tau Txais
Qhov kev pab no muaj rau koj yam tsis tau them nyiaj. Koj yuav cia li raug muab rau npe rau hauv qhov Kev Pab Muab Tshuaj Kho Mob (Medication Therapy Management) yog hais tias koj:
- noj txog yim (8) los yog ntau dua cov tshuaj Part D rau cov mob tsis txawj zoo, thiab
- muaj txog peb (3) cov teeb meem mob mus sij hawm ntev los yog ntau dua nyob ntawm daim ntawv teev cov npe nram qab no:
- Mob COPD (Mob hlab ntsws txhaws mob ntev tsis txawj zoo)
- Mob ntshav qab zib
- Plawv Tsis Muaj Zog
- Muaj Roj Cholesterol Siab
- Mob pob txha yaig
- thiab zoo ntxim li yuav siv ntau tshaj $5330 ib lub xyoos txog ntawm cov tshuaj ntawm Part D uas tau txais kev pab them nqi duav roos
LOS SIS
- yog nyob hauv ib qho Kev Pab Tswj Hwm Tshuaj (Drug Management Program) los pab koj tswj hwm kev siv tshuaj thiab kom muaj kev nyab xeeb xws li cov tshuaj daws mob ntawd.
Yam Uas Koj Yuav Tau Ua Yog Dab Tsi
Li 60 hnub tom qab muaj feem tau txais qhov kev pab MTM, koj yuav tau txais ib daim ntawv xa tuaj rau koj kom ua tiav qhov Kev Nrog Xyuas Kev Siv Tshuaj (Comprehensive Medication Review (CMR)). Tej zaum koj kuj tseem tau txais qhov no uas yog hu xov tooj tuaj.
Koj tuaj yeem ua tiav qhov CMR hauv lub xov tooj los yog nrog ib tus kws muab kev kho mob tham kiag tim ntsej tim muag. Qhov no siv sij hawm li ntawm 30 feeb (minutes). Ib tus kws muag tshuaj, los yog ib tus kws kho mob CMR tsim nyog, yuav xyuas koj li keeb kwm kev noj tshuaj, suav nrog cov tshuaj uas kws kho mob sau ntawv yuav thiab cov uas koj cia li yuav tau ntawm txee muag tshuaj, thiab saib seb puas muaj teeb meem dab tsi.
Muaj Dab Tsi Ntxiv Tom Ntej
Li 14 hnub tom qab ua tiav qhov CMR, koj yuav tau txais ib co ntawv muaj cov ntsiab lus hais txog qhov nrog xyuas no thiab tau sib tham tias yuav tau ua dab tsi thiab cov npe tshuaj uas tam sim no koj noj thiab yog vim li cas koj thiaj noj. Qhov no yog ib qho pab tau thaum koj ntsib nrog koj tus kws kho mob los yog kws muag tshuaj. Cov lus muab tau los tej zaum yuav muab xa rau koj tus kws kho mob. Ib qho ntxiv, cov tswv cuab uas nyob hauv qhov kev pab MTM yuav tau txais cov ntaub ntawv qhia tias yuav muab tej tshuaj coj mus pov tseg li cas thiaj muaj kev nyab xeeb suav nrog rau tej yeeb tshuaj uas tswj los ntawm tsoom fwv.
Koj kuj tseem mus rub tau (download) ib daim Ntawv Teev Cov Npe Tshuaj (PDF) rau koj tus kheej siv.
Ntxiv rau ntawm qhov CMR, Cov Kev Nrog Xyuas Kev Siv Tshuaj Ib Qhov Twg Kiag (Targeted Medication Reviews) yog muaj tsawg kawg peb lub hlis ib zaug. Qhov no yog los nrhiav kom paub seb puas muaj cov kev sib twv ntawm ob hom tshuaj sib txawv los yog lwm yam kev txhawj xeeb hais txog tshuaj. Cov kev nrog xyuas no yuav muab xa rau koj tus kws kho mob.
Qhov kev pab Kev Tswj Hwm Muab Tshuaj Kho Mob (Medication Therapy Management) tsis yog daim phiaj ib qho kev pab. Yog xav paub ntxiv txog UnitedHealthcare qhov kev pab Kev Tswj Hwm Muab Tshuaj Kho Mob no, thov hu rau tus xov tooj nyob sab nraum qab ntawm koj daim npav ID ua tswv cuab los yog koj hu tau rau OptumRx MTM qhov chaw ntawm 1-866-216-0198, TTY 711, hnub Monday – Friday 9AM – 9PM Lub Sij Hawm Sab Hnub Tuaj.
Nrhiav ib Lub Khw Muag Tshuaj
2024 Provider/Pharmacy Directories
Pharmacies
This part of the Directory provides a list of pharmacies in UnitedHealthcare Connected® for One Care network. These network pharmacies are pharmacies that have agreed to provide prescription drugs to you as a member of the plan.
- UnitedHealthcare Connected® for One Care 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 One Care toll-free Member Engagement Center 1-866-633-4454 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 One Care 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® network pharmacies in your area, please visit our web site at www.UHCCommunityPlan.com or call Member Engagement Center at 1-866-633-4454, TTY users should call 711, 8 AM - 8 PM, local time, Monday - Friday. Qhov kev hu xov tooj no tsuas yog hu dawb xwb.
To get a complete description of your prescription coverage, including how to fill your prescriptions, please read the Member Handbook and UnitedHealthcare Connected® for One Care List of Covered Drugs. You received the List of Covered Drugs in the mail when you became a member of this plan.
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 prescription 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 1-866-633-4454, TTY 711, 8 AM - 8 PM, local time, Monday - Friday.
Home Infusion Pharmacies
You can get home infusion therapy if UnitedHealthcare Connected® for One Care 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 Engagement Center at 1-866-633-4454, TTY 711, 8 AM - 8 PM, 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® through the facility’s pharmacy or another network pharmacy.
For more information, you can call Member Engagement Center at 1-866-633-4454, TTY 711, 8 AM - 8 PM, local time, Monday - Friday.
Prescription orders sent directly from your doctor must have your approval before we can send your medications. This includes new prescriptions and prescription 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.
Nrhiav ib Tus Kws Kho Hniav
Tshawb Nrhiav Ib Tus Kws Kho Hniav
Nhriav ib tus kws kho hniav hauv koj cheeb tsam. Nias rau ntawm “Ntshawb Nrhiav ib Tus Kws Kho Hniav” (Search for a Dentist) hauv qab no los pib koj qhov kev tshawb nrhiav.
Kawm ntxiv
UnitedHealthcare Connected® for One Care (Medicare-Medicaid Plan)