The amount a Member may be required to pay directly to a
Participating Provider or a Non-Participating Provider for certain
Covered Services as set forth in Article IX of the COC.
E
Excluded Services
Services that are not covered under the Medicaid benefit.
G
Grievance
A complaint submitted on behalf of a member.
M
Medically Necessary
The services, equipment or supplies necessary for the diagnosis, care
or treatment of a member's physical or mental condition according to
accepted medical practices and standards.
N
Non-Participating Provider
A Health Professional, Hospital, healthcare entity or health care
professional that has not contracted with UnitedHealthcare Community
Plan to provide Covered Services to Members.
P
Participating Provider
A Health Professional, Hospital or other entity that contracts with
UnitedHealthcare Community Plan to provide Covered Services to Members.
PCP
Primary Care Provider (Your personal doctor).
R
Referral
When your Primary Care Provider sends you to a Specialist for a
covered service.
U
Urgent Care
Covered services that are not Emergency Services, but are Medically
Necessary and immediately required as a result of an unforeseen
illness, injury, or condition.
