UnitedHealthcare Community Plan for Families Ntsiab Lus Tshab Txhais

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A decision about your health care that you make ahead of time in case you are ever unable to speak for yourself. This will let your family and your doctors know what decisions you would make if you were able to.

ASC/SPU

Ambulatory surgical center/short procedure unit.

Authorization

An O.K. or approval for a service.

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Services, procedures and medications that UnitedHealthcare Community Plan for Kids will cover for you.

Clinical Care Management

One-on-one help by a nurse providing education and coordination of UnitedHealthcare Community Plan for Kids benefits, tailored to your needs.

Disenrollment

To stop your membership in UnitedHealthcare Community Plan for Kids.

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When you reasonably believe that your health is in serious danger.

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An untruthful act – an example is someone other than you using your UnitedHealthcare Community Plan for Kids member ID card and pretending to be you.

Home Health Agency

A company hired by UnitedHealthcare Community Plan for Kids to provide care for you in your home.

ID Card

Identification card – a card that says you are a UnitedHealthcare Community Plan for Kids member. You should have this card with you at all times.

Informed Consent

You agree to all medical treatments.

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When you are admitted into a hospital for a length of time.

Medical Necessity

Your health care provider decides if a treatment, admission, procedure, medical supply, equipment, service or supply is medically necessary.

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A person who is eligible for UnitedHealthcare Community Plan for Kids.

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Primary Care Physician (PCP)

A doctor you choose to be your family physician. They have their own private practices.

Prior Authorization

The process for any service that needs an O.K. from UnitedHealthcare Community Plan before it can take place. 

If you have questions about prior authorization please call Customer Service at 888-611-2341, Monday – Friday, 8 AM - 6 PM Central Time.

Providers can check on the status of an existing request by calling our clinical authorization services at 866-604-3267, 24 hours a day, seven days a week.

If you have questions about a pharmacy prior authorization, please call our Pharmacy Help Desk at 800-310-6826. You can get answers to prescription prior authorization questions Monday – Friday, 7 AM to 7 PM Central Time, with voicemail intake after-hours.

Additional information can be found on our Provider Prior Authorization and Notification page.

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Any medical professional that UnitedHealthcare Community Plan has contracted with to take care of you.

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A list of providers who participate with UnitedHealthcare Community Plan for Kids to help take care of your healthcare needs.

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When you and your primary care provider agree you need to see another doctor, your primary care provider will send you to a UnitedHealthcare Community Plan for Kids specialist.

Self-Referred Services

Services for which you do not need to see your primary care provider for a referral.

Special Needs Unit (SNU)

A voluntary service offered by UnitedHealthcare Community Plan for Kids that can give you extra help in understanding and using your benefits if you have a disability or other special need.

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A doctor that has specific, detailed training in one certain medical field.

Treatment

 The care that you may receive from doctors and facilities.

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When you need care, treatment or medical advice within a 24-hour time period.

WIC

Women, Infants and Children program, a supplemental nutrition program that provides nutritious food, education support and health care referrals for women, infants and children.