Why did I receive this bill?
Some examples of why you may receive a bill.
- Co-pay amount.
- Deductible amount.
- Co-Insurance amount.
- Out of network amount.
- Non-covered service.
- Insurance card not presented/wrong insurance card.
- Name changes.
What is a Deductible?
DEDUCTIBLE- The dollar amount of covered expenses that the claimant must incur before benefits are payable.
What is Co-Pay?
CO-PAYMENT- A specified dollar amount that a member must pay out-of- pocket for a specified service at the time the service is rendered.
What is Co-Insurance?
CO-INSURANCE- A dollar amount (usually determined as a percentage of total covered expenses) by which covered expenses are reduced before a benefit payment is made.
If my provider receives pre-authorization, does that mean the service is covered?
Pre-authorization does not guarantee coverage. Contact the customer service department at 1-888-779-6872 to verify if a service is covered.
How do I locate a doctor in my area?
Medical Providers – To find medical providers in network in your area:
- Log onto https://www.whyuhc.com/uhss
- Scroll down and Select “Find a doctor or facility” for Medical providers.
- Choose “Search the provider network: OPTIONS PPO”
- Change the location if different then where you are located.
- In the search bar add providers name, hospital, or type of service.
Mental Health Providers - To find Mental Health Providers in network in your area:
- Log onto https://www.whyuhc.com/uhss
- Scroll down and Select “Find a doctor or facility”
- Scroll and Select “Search the Network for UnitedHealthcare Behavioral Health Providers”
- Change the location if different then where you are located.
- In the search bar add providers name, procedure or condition.
Vision - Call Pequot Plus Health Benefit Services at 888-779-6872.
Dental- Call Pequot Plus Health Benefit Services at 888-779-6872.
When was my last Vision exam?
Call Pequot Plus Health Benefit Services at 888-779-6872 and the representative can give you the date of your last Vision exam.
We are allowed one routine eye-exam each year, why did they charge me a Co-Pay?
Yes, you are allowed one routine exam each year;
- If the diagnosis is not routine.
- The routine eye exam only pays $30.00 per year, the providers can bill you up to charge.
If I show my insurance card to the provider does that guarantee payment?
Unfortunately, it does not; you should always call customer service to verify if the service is covered.
Who can I call regarding my questions?
Please call Pequot Plus Health Benefit Services at 888-779-6872.