UnitedHealthcare

Can I select a Virginia Mason primary care provider with this insurance plan?

Yes

Does this plan require pre-approval to see a specialist?

No

General Comments

HMO: Referral for specialty care is required when one of the below primary care practices have been selected (please provide referral authorization number when scheduling an appointment):

• Highline Medical Services Organization,
• Physicians Care Network,
• NW Physicians Care Network, or
• Everett Clinic Primary Care Provider.

If not under one of the above mentioned practices, approved specialty care referrals are not required. However, some services may require prior-authorization.

*When prior-authorizing for the Medicare programs always use the UHCWest website. Unless the Medicare program is Community Plan Dual Complete. If Community Plan Dual Complete, use UnitedHealthcareonline.

Can I select a Virginia Mason primary care provider with this insurance plan?

Yes

Does this plan require pre-approval to see a specialist?

Yes/No*

General Comments

HMO: Referral for specialty care is required when one of the below primary care practices have been selected:

• Highline Medical Services Organization,
• Physicians Care Network,
• NW Physicians Care Network, or
• Everett Clinic Primary Care Provider.

If not under one of the above mentioned practices, approved specialty care referrals are not required. However, some services may require prior-authorization.

*When prior-authorizing for the Medicare programs always use the UHCWest website. Unless the Medicare program is Community Plan Dual Complete. If Community Plan Dual Complete, use UnitedHealthcareonline.

Can I select a Virginia Mason primary care provider with this insurance plan?

Yes

Does this plan require pre-approval to see a specialist?

No

Can I select a Virginia Mason primary care provider with this insurance plan?

No

Does this plan require pre-approval to see a specialist?

*Yes

General Comments

• * Core — Virginia Mason is not contracted for this program. Patients utilizing Virginia Mason will be out-of-network. If patient does not have an insurance authorized referral, patient will have a greater out-of-pocket financial responsibility.
   
• Core Essential — Virginia Mason is not contracted for this program. Patients utilizing Virginia Mason will be out-of-network. If patient does not have an insurance authorized referral, services will not be covered and patient will have full financial responsibility. Unless emergency, please do not schedule until patient has an insurance approved referral.

Can I select a Virginia Mason primary care provider with this insurance plan?

No

Does this plan require pre-approval to see a specialist?

Yes

General Comments

HMO: Referral for specialty care is required when one of the below primary care practices have been selected:

• Highline Medical Services Organization,
• Physicians Care Network,
• NW Physicians Care Network, or
• Everett Clinic Primary Care Provider.

If not under one of the above mentioned practices, approved specialty care referrals are not required.  However, some services may require prior-authorization.

*When prior-authorizing for the Medicare programs always use the UHCWest website. Unless the Medicare program is Community Plan Dual Complete. If Community Plan Dual Complete, use UnitedHealthcareonline.

Can I select a Virginia Mason primary care provider with this insurance plan?

Yes*

Does this plan require pre-approval to see a specialist?

Yes*

General Comments

Not accepting new patients for primary care selection.

Accepting only for patients already established in primary care.

Accepting for psychiatry.

Accepting new underage children with Down Syndrome, accessing Dr. Rebecca Partridge

Accepting all newborns into our pediatric panels

Insurance approved referral is not needed if patient selected a Virginia Mason primary care provider (PCP)

Approved referral are required when patient has a PCP under the following groups:

• Highline Medical Services Organization
• NW Physicians Network (including ACO)

Can I select a Virginia Mason primary care provider with this insurance plan?

Yes

Does this plan require pre-approval to see a specialist?

No

Can I select a Virginia Mason primary care provider with this insurance plan?

No

Does this plan require pre-approval to see a specialist?

Yes

Can I select a Virginia Mason primary care provider with this insurance plan?

Yes

Does this plan require pre-approval to see a specialist?

Yes/No*

General Comments

* This program is geographically specific. For example: If a patient buys the coverage in California, they are only covered in California, if they buy it in Washington state, they are only covered in Washington state (unless emergency). They may only select a Virginia Mason PCP if they have the coverage in Washington state. If needing specialty care and coming from another state, they must have an approved referral.

Can I select a Virginia Mason primary care provider with this insurance plan?

Yes

Does this plan require pre-approval to see a specialist?

No