Transition of Care

HOW WILL TRANSITION OF MY CARE WORK MOVING FROM A KAISER DOCTOR TO A UNITED HEALTHCARE DOCTOR?

MEDICAL:

Transition of Care gives new UnitedHealthcare members the opportunity to request extended coverage for their current, out-of-network health care professional at network rates due to qualifying medical conditions, until the safe transfer to a network health care professional can be arranged. Members must apply for Transition of Care no later than 30 days after the effective date of coverage.

PHARMACY:

We also have Pharmacy Transition of Care in place to allow new UHC members to receive a one-time 30-day grace fill override on certain medications that are excluded or require prior authorization. This allows members more time to work with their provider to either switch to a covered alternative or satisfy the prior authorization requirement in place. To be eligible, members must adhere to the specific requirements below.

  • The member must call UnitedHealthcare member services using the number located on the back of their ID card to obtain the override.
  • New members are asked to verbally confirm their prior carrier had been covering the drug in question. They do not need to show proof.
  • The UHC representative will provide education on preferred alternatives and/or the Prior Authorization process.
  • The UHC representative will evaluate whether the drug in question is eligible for Transition of Care in the Formulary Lookup. Specialty medications are not eligible for transition of care.
  • If the drug is eligible for Transition of Care, the UHC representative will facilitate the override request by engaging OptumRx member services, if necessary.
  • Transition of Care does not apply to all medications. To check if a drug is eligible prior to contacting UnitedHealthcare, members can go to Pharmacy benefits (whyuhc.com), scroll about halfway down the page, select the PDL specific to the plan they are enrolling in and enter the drug name in the search field. After searching for the drug, click on coverage details then scroll to the bottom of the page and it will say “yes” next to Transition of Care if it applies.