Frequently Asked Questions

1. Does Unity offer Medicare Part D?
2. Who are my participating providers?
3. What is a primary care physician (PCP)?
4. Do I need to choose a PCP?
5. Can I change my PCP?
6. Do I need to see my PCP for all my health care?
7. What if I need to see a specialist?
8. What if I need behavioral health (mental health) services?
9. Do I need prior authorization for certain services?
10. Who files claims when I receive health care services?
11. What preventive care coverage do I have?
12. What is considered an emergency or urgent care situation?
13. What should I do if I need emergency or urgent care?
14. What if I have urgent health care needs or need care outside Unity’s service area?
15. What is Quality Improvement? Does Unity have a Quality Improvement program?
16. Additional Questions?

Does Unity offer Medicare Part D?
Unity does not offer Medicare Part D. If you are interested in purchasing a Medicare Part D plan, we can provide information about companies who offer this plan. 

Who are my participating providers?
You can find a list of participating providers (doctors, hospitals and other health care facilities) by visiting Find a Doctor or in the Medicare Select Provider Directory. 

What is a primary care physician?
A primary care physician (PCP) is a doctor who manages your health care so you receive consistent medical care in an effective and efficient manner. Your PCP will coordinate your medical care through the use of participating specialty practitioners.

Do I need to choose a PCP?
Unity requires all members to have a PCP. To select your PCP, Unity provides you with the following options:

• Choose a PCP from the list of participating practitioners found within Find a Doctor at unityhealth.com or in the Medicare Select Provider Directory
  or
• Choose a participating clinic and Unity will assign a PCP at the clinic
  or
• Have Unity assign you a PCP and clinic close to your home. 

If you’d like to select a PCP at a UW Health clinic and need help selecting one, contact the UW Health Welcome Center at 800-552-4255 Monday through Friday from 8 a.m. to 5 p.m. You can also send an email to patient.resources@uwmf.wisc.edu.

Can I change my PCP?
Yes. PCP changes are effective no later than the first day of the following month. There are two convenient ways to change your PCP:

1. Go to unityhealth.com and login to MyChart
2. Call Unity Customer Service at 800-548-6489 and press 2
    

Do I need to see my PCP for all my health care?
You should talk with your PCP before seeing other types of practitioners so he/she may coordinate your health care.

What if I need to see a specialist?
You should work with your PCP to determine if you need specialty care. If you do, he/she will refer you to an appropriate specialist who is participating for you.

What if I need behavioral health (mental health) services?
Unity offers a service to assist you with your behavioral health care needs. UW Behavioral Health is a triage line staffed by experienced mental health clinicians. They will help you make an appointment and ensure you see the correct type of behavioral health practitioner for your specific needs. Call UW Behavioral Health at 800-683-2300 or 608-233-3575 for prior authorization of all mental health assessments and treatments.

Do I need prior authorization for certain services?
Yes. Specific types of services require you to receive prior authorization before the services are received. You will need a prior authorization if you wish to receive services from a non-participating provider.

Who files claims when I receive health care services?
When you receive care from participating practitioners, the practitioner will submit the claim for you. If you receive a bill from a participating practitioner prior to receiving your Explanation of Benefits, please send a message to Unity Customer Service through Ask an Expert within MyChart or call 800-362-3310.

What preventive care coverage do I have?
Preventive care services are covered by your plan without a copayment, coinsurance or deductible when received by a participating primary care provider.

What is considered an emergency or urgent care situation?
An emergency medical condition is one that manifests itself by acute symptoms of sufficient severity, including severe pain, to lead a prudent layperson who possesses an average knowledge of health and medicine to reasonably conclude that a lack of immediate medical attention will likely result in any one of the following:

• Serious jeopardy to the person’s health or, with respect to a pregnant woman, serious jeopardy to the health of the woman or her unborn child.
• Serious impairment to the person’s bodily functions.
• Serious dysfunction of one or more of the person’s body organs or parts. 

Urgent care services are those needed due to illness or symptoms where delay in care could jeopardize your health or result in disability.

What should I do if I need emergency or urgent care?
If you have an emergency condition, get help first. For urgent situations, contact your primary care clinic. They will tell you how to get appropriate care. Remember, if you receive emergency or urgent care from a non-participating provider you need to contact Unity Customer Service within three days of receiving the care.

What if I have urgent health care needs or need care outside Unity’s service area?
If you have a life-threatening medical situation, call 911 or go directly to the nearest medical facility. If you believe you need urgent care, contact your PCP clinic first, even after clinic hours or if you are outside of Unity’s service area. If you receive urgent care or emergency treatment from a non-participating provider you need to contact Unity Customer Service within three business days of receiving the care so we can make sure your claims are paid correctly. 

What is Quality Improvement? Does Unity have a Quality Improvement program?
Quality Improvement (also called Quality Assurance) is a process designed to measure and track the continuous improvement of care and services offered to Unity members. Unity’s Quality Improvement processes identify opportunities to improve care and service, identify actual or potential problems and identify trends which suggest variation in the outcome of care and services received.

The scope of Unity’s Quality Improvement Program includes preventive, acute and chronic care services; services received in inpatient and outpatient settings; and PCPs, specialists and other practitioners involved in delivering care to you. You can obtain more information about Unity’s Quality Improvement Program by calling 866-884-4601.

If you have additional questions about Medicare Select, contact Unity’s Individual Product Account Executive at 608-643-1436 or via email.

Unity Health Plans Insurance Corporation and its representatives are not connected with Medicare. This is an advertisement for health insurance through Unity Health Plans Insurance Corporation.