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UnitedHealthcare Community Plan KanCare Frequently Asked Questions
What is KanCare?
KanCare is the name for the State of Kansas’ Medicaid program. UnitedHealthcare serves the State of Kansas to provide health care and long-term services and supports. You can learn more about KanCare at www.kancare.ks.gov.
What is Medicaid?
Medicaid is a state and federal program that pays medical bills for low-income people, or persons who need long-term services and supports.
What services can I get through UnitedHealthcare?
We provide all the benefits covered under KanCare to help you live well, including:
- Visits to your primary care provider (PCP) and specialists.
- Medicines, medical supplies and shots.
- Urgent and emergency care.
- Getting care in the hospital.
- Rides to and from medical appointments.
- Extra services beyond KanCare coverage. To learn more see our Value Added Benefits.
How do I apply for KanCare?
If you do not currently have coverage for KanCare, you can apply online. To apply for medical coverage, you must complete and submit an application. There are two applications. One application is for families with children. The second is for Individuals with disabilities and the frail elderly. You can apply for KanCare if you believe you may qualify to receive long-term services and supports or Home- and Community-Based Services (HCBS). Please make sure you check the box on the application that asks "Does this person need help with nursing home costs or in-home care?"
You can find the link to the application at www.kancare.ks.gov or get information by calling: 1-800-792-4884.
How do I enroll with UnitedHealthcare Community Plan?
You can choose UnitedHealthcare during the Open Enrollment Period October 1, 2018 through April 3, 2019. Simply select UnitedHealthcare in the packet you receive in the mail, or using the online application on the KanCare Enrollment Center. You can also call at 1-866-305-5147 and tell the representative you want UnitedHealthcare.
Who do I call if I have a question?
If you have questions you can call Member Services a 1-877-542-9238. We can help with:
- Answers to question you may have about your health care benefits or services.
- General health information.
- Request a change to your primary care physician.
- To request a replacement member ID card.
- To learn how to take advantage the value added benefits.
How do I choose a Primary Care Provider (PCP)?
You may choose any plan provider to be your Primary Care Provider. Plan Providers are listed in the provider directory or you may call Member Services for assistance in finding a plan provider at 1-877-524-9238.
How does my Primary Care Provider help?
Your Primary Care Provider can help you with all of your health care needs and should always be a part of your medical care team. Your Primary Care Provider and staff should:
- Refer you to a specialist when necessary.
- Give you advice or appointments.
- Admit you to a hospital if medically necessary.
- Be called if an emergency happens. For a life threatening injury or illness call 911 or go to your nearest emergency room.
Can I change my PCP after I enroll?
How can I switch to another Primary Care Provider?
Your Primary Care Provider is important to your health care. If you are unhappy with your doctor, please talk with him or her so that they know why you are unhappy. Your doctor can only correct a problem that he/she knows about.
What if my doctor or other provider leaves the plan?
Sometimes a Primary Care Provider, specialist, clinic, hospital or other plan provider you are using might leave the Plan. If this happens, you will have to switch to another provider who is part of our Plan. If your Primary Care Provider leaves our Plan, we will let you know and help you choose another Primary Care Provider so that you can keep getting covered services.
What happens if I travel outside of Kansas and I need medical care?
When you are outside the service area, you are only covered for emergency and urgent care. If you have questions about your medical costs when you travel, please call: 1-877-542-9238.
What is a medical emergency?
A “medical emergency” is when you reasonably believe that your health is in serious danger – when every second counts. A medical emergency includes severe pain, a bad injury, a serious illness, or a medical condition that is getting worse.
How do I know if it is a medical emergency?
Call our 24-hour Nurse Hotline to speak with a nurse. The nurse can help you decide if it is an emergency.
How do I use the plan ID Card?
You will receive an ID card after you enroll that shows that you are a member of the UnitedHealthcare Community Plan. Carry the ID card with you at all times and show the ID card each time you receive medical care.
How do I get prescriptions?
Take your prescription and your UnitedHealthcare Community Plan Member ID Card to any pharmacy that participates with UnitedHealthcare Community Plan. The pharmacy will accept your ID Card as payment for the prescription. Check the Preferred Drug List on this website to see which items require prior authorization.
How do I know what medications are covered?
Your plan covers a long list of medicines, or prescription drugs. Medicines that are covered are on the plan’s Preferred Drug List (PDL) or Formulary.
What is a Preferred Drug List (PDL)?
The PDL is a subset of all drugs covered under the plan. Your Doctor uses these lists to make sure the medicines you need are covered by your plan. If your prescriptions are not on the Preferred Drug List or Formulary, schedule an appointment with your doctor within the next 30 days. They may be able to help you switch to a drug that is on the Preferred Drug List or Formulary. Your doctor can also help you ask for an exception if they think you need a medicine that is not on the list.
What is a Prior Authorization?
In some cases your provider must get permission from the health plan before giving you a certain service. This is called prior authorization. This is your provider’s responsibility. If they do not get prior authorization, you will not be able to get those services. Some services that need prior authorization include:
- Hospital admissions.
- Certain outpatient imaging procedures, including PET scan imaging procedures.
- Some Durable Medical Equipment services.
- Some prescription medications.
- Weight loss surgery.
What does Medically Necessary mean?
- Is care to prevent, diagnose or treat a physical or mental illness or injury. Care that Is needed for proper development. Care that helps minimize a disability. Is done to maintain or regain function.
- To not get care would adversely affect the condition or the quality of medical care.
- Is care given in the most appropriate setting.
What should I expect as a new member of this plan?
As a new member you should expect to receive your UnitedHealthcare Community Plan ID card within 10 days of joining the plan. You should also receive your new member welcome kit which includes your Member Handbook, the Provider Directory and other important information,
Additionally, we will contact you by phone to welcome you to the plan and conduct a welcome call and a health risk assessment (HRA). The welcome call is a great way to learn about the benefits available to you under the plan. UnitedHealthcare Community Plan reviews all HRAs and identifies members with chronic and long term medical conditions that we can help you manage. In some cases, you may be assigned a Care Coordinator who will work with you and your physician to manage your healthcare needs.
Do I need to schedule appointments?
It is always a good idea to schedule appointments with your providers. You should arrive early for your appointment so you have enough time to complete any forms your provider may need from you.
If you are unable to keep an appointment, please call your provider to let him/her know you cannot make it. This will allow your doctor to schedule other patients.
What if I need an Interpreter?
We can help you if you do not speak or understand English. We have advocates that speak different languages. If you we don’t have an advocate who speaks your language, we will arrange for an interpreter to help us with your call. Please call Member Services at 1-877-542-9238, TTY 711 and notify our advocate what languages you speak. If you need an interpreter when you visit your doctor, ask the doctor’s office to arrange for one.
What if I don't agree with a decision made about my health care?
You have the right to voice concerns about your health care.
You may file a grievance if:
You are concerned about the type of care you are getting. You are concerned about the quality of the care you are getting. You have other concerns about us or your provider. If you are unhappy or concerned about the quality of care you received, you can file a grievance to be referred to our Medical Peer Review Committee. You may file a grievance at any time.
You may appeal:
An appeal is when you ask for a review of an adverse benefit determination. An adverse benefit determination is when we:
- Deny or limit a service you want.
- Reduce, suspend or terminate payment for a service you are getting.
- Fail to authorize a service in the required time.
- Fail to respond to a grievance in the required time
You must complete an appeal before you can request a State Fair Hearing.
You may request a State Fair Hearing. A State Fair Hearing is like a trial in court. The hearing is your chance to tell a third party why you disagree with the agency. You must request a fair hearing within 120 calendar days (an additional 3 calendar days is allowed for mailing) of decision the notice of the adverse benefit determination. For more information on the fair hearing process, please call Member Services at 1-877-542-9238.
What options do I have if I need a service that is not covered by KanCare?
Most of the time service that is not covered by KanCare or through a Value Added Benefit will have to paid out of pocket. In some cases UnitedHealthcare can pay for a product or service for you though a program called In Lieu of Services. In Lieu of Services must be approved by the State and go through a Prior Authorization process. The process can be started by your Service Coordinator or your Provider. All request are reviewed by our clinical staff.
What help can I get if I want to quit smoking?
For the first time, KanCare is covering quit smoking medications and counseling, for more than one attempt to quit in a year:
- Tobacco cessation medications, including the nicotine patch, gum, lozenge, inhaler, nasal spray, Chantix or Zyban are covered.
- You can combine cessation medications, like the patch and gum.
- You can get counseling services while you try to quit.
- You can try more than once a year to find what helps you quit for good.
Click here for more information on the expanded benefits from KanCare.
UnitedHealthcare Community Plan KanCare
- Frequently Asked Questions
- Links to Health Information
- 2023 Value Added Benefits