• What is the difference between "participating" and "non-participating" providers?
• How can I find out if my healthcare provider is a participating provider?
• How do I get reimbursed for services received from a non-participating provider?
• How do I get reimbursed for emergency services received in a foreign country?
• If I should become injured or ill while traveling within the U.S., will my medical care be covered?
• If I am attending college, working or living on the mainland, or on COBRA, how do I facilitate my medical care?

 

Q. What is the difference between "participating" and "non-participating" providers?

A. Participating providers have a signed contract with UHA, and receive reimbursement of eligible charges directly from UHA. From a member perspective, only a co-payment, co-insurance, and payment for non-covered items (if any) may be required at the time of service.

All other providers, without signed UHA contracts, are considered non-participating providers. Non-participating providers may collect their full charge(s) from the member at the time of service.

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Q. How can I find out if my healthcare provider is a participating provider?

A. Participating providers can be found in our Provider Directory. You may also request a hard copy of the Provider Directory from Member Services.

UHA's directories are subject to change. For verification of the most current provider participation status, call the provider's office.

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Q. How do I get reimbursed for services received from a non-participating provider?

A. Either the non-participating provider or the member must submit a completed and signed standard claim form*. Most providers will submit this claim on your behalf.

Members are responsible for the total amount billed, usually at the time of service, and UHA will make reimbursements for any covered charges directly to the member. Therefore, the Member is responsible for all non-covered charges, including the difference between the billed charges and UHA's eligible charges, any co-payments, co-insurance, and deductibles.

UHA will not accept invoices or receipts as claim forms for services rendered in the U.S.

* Standard claim forms are:
• Inpatient/Outpatient facilities - UB92/CMS 1500
• Professional/Other services - CMS 1500
• Prescription drugs - DAH 3PT-1000

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Q. How do I get reimbursed for emergency services received in a foreign country?

A. Traveling to a foreign country for the purpose of receiving services is not a covered benefit, even if referred by your physician. Only urgent or emergency medical services performed outside the U.S. will be covered.

Claims for services rendered by a foreign provider must be fully translated to English and must contain:

• Patient's name
• Patient's date of birth
• Diagnosis
• Procedures done with dates of service and charges (listed separately)
• Name and address of the provider of service
• Name and address of the facility where services were rendered
• Your receipt of payment made, converted to U.S. Dollars and the rate of exchange on the dates of service
  

In certain instances, we may require additional documentation such as admission and discharge summaries, or daily hospital records.

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Q. If I should become injured or ill while traveling within the U.S., will my medical care be covered?
A. Yes. If you become injured or ill while traveling within the U.S., any emergency care, urgent care, or hospitalization will be covered according to your plan benefits. We are partnered with a mainland network called First Health Network, and seeing a First Health participating provider can significantly limit your out-of-pocket expenses. We recommend checking to see if there is a First Health participating facility in the area of travel.

Treatment for a condition which occurred or was diagnosed before your trip will be subject to the same prior authorization requirements as any non-urgent treatment outside of the State of Hawaii. Contact Health Care Services with any questions.

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Q. If I am attending college, working or living on the mainland, or on COBRA, how do I facilitate my medical care?

A. Notify Employer Services regarding your out-of-state address.

You also have access to First Health Network, our partner mainland network of providers, and one of the nation's largest and most respected national PPO networks. Selecting a First Health Network participating provider is a benefit to you and provides a significant cost saving over a non-participating provider.

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