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Legal Update - 2.10.16
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United Healthcare:

No new information here.


As always should you continue to have take backs from UHC you should appeal those decisions.



No new Updates at this time.  Still waiting for the US Court of Appeals to render an opinion.


We will continue to update our membership as we gain more information.


If you are still having issues with Humana taking monies it is important that you appeal this decision.



Pre-Authorization Email:

Earlier in the month OPTUM sent out an email to all of its providers talking about their Navigate product.  This product is very reminiscent of the old HMO products.  This product requires that patients have a referral and pre-authorization for chiropractic. OPTUM has sent this same notification out to Ohio providers every year for the last three years. Each year the OSCA will reach out to OPTUM to find out if there is any product of this nature in circulation in Ohio. This year is no different than the years prior; there are no plans in Ohio that currently use the Navigate product. 


Members should train their staff to visually inspect all UHC insurance cards.  If there is notation on the card that states it is a “Navigate” product then you will need a referral.  We also ask that you let the OSCA know you have that product in circulation in your area.


       Per Diem Info:

There is a national call on February 9th with all of the states that are affected by the new Per Diem policy. We hope to hear some new information that will help our members with this continued issue.


We will provide further updates to our members as we continue this effort.

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