UnitedHealthcare Community Plan of NJ Contract Termination: Answering a Family's Questions

Please find here the letter sent to families:

What is happening?

UnitedHealthcare Community Plan of NJ (UHCCP NJ) has indicated its intention to terminate its contract with CHOP and all CHOP physicians, effective Dec. 1, 2020.

My child is scheduled for services at CHOP before Dec. 1, 2020. What should I do?

Your child will be able to access CHOP hospital and specialty services prior to Dec. 1, 2020, with authorizations from UHCCP NJ. If additional care is needed on or after this date, authorization from UHCCP NJ will be needed.

My child is scheduled for surgery at CHOP before Dec. 1, 2020. Will my child be able to receive follow-up care for that surgery?

Your child will be able to receive postoperative care for the same diagnosis for up to six (6) months (through May 31, 2021) with authorizations from UHCCP NJ. The surgical division may be able to assist you with getting these authorizations.

My child is an oncology patient. How does this affect my child?

Your child may continue to receive oncologic treatment from CHOP for one (1) year (through Nov. 30, 2021) with authorizations from UHCCP NJ. The CHOP oncology financial counselors will assist you with obtaining these authorizations.

My child sees several CHOP specialists every four (4) months, and the next set of appointments is scheduled for after Dec. 1, 2020. What can I do?

Your child may continue to see their CHOP specialists prior to Dec. 1, 2020. For appointments scheduled on or after Dec. 1, 2020, please call UHCCP NJ Member Services at 1-800-941-4647 or the number on the back of your child’s health plan ID card and request authorization to continue treatment with your CHOP physician which began before Dec. 1, 2020. UHCCP NJ may authorize continued care with your CHOP physician through March 31, 2021. UHCCP NJ is required to help identify and secure appropriate providers for your child. The CHOP specialist divisions may be able to assist you with obtaining authorization for follow-up appointments scheduled on or after Dec. 1, 2020.

If my child’s care is not authorized by UHCCP NJ on or after Dec. 1, 2020, what are my out-of-pocket responsibilities?

Without authorization for CHOP services by UHCCP NJ, CHOP will advise you of the out-of-network costs and ask you to complete and sign a Notice of Insurance Information and Payment Obligations form, acknowledging that you wish to go out of network and accept personal financial responsibility for the anticipated costs of your child’s care at CHOP.

Can my child still see their CHOP New Jersey Care Network Primary Care doctor?

If your child is a current patient of a CHOP New Jersey Care Network Primary Care doctor, your child can continue seeing their CHOP New Jersey Care Network Primary Care doctor after Dec. 1, 2020.

I am a pregnant woman under the care of CHOP’s Center for Fetal Diagnosis and Treatment. What should I do?

You do not need to take any action at this time. UHCCP NJ is required to cover your obstetrical care at CHOP through your pregnancy and up to six (6)weeks after delivery for obstetrical/ fetal care. My child sees a specialist at one of the CHOP Specialty Care Centers in New Jersey. Who can I call for more information? If your child sees a CHOP New Jersey Care Network Primary Care doctor, please contact that doctor’s office for more information. If your child does not see a CHOP New Jersey Care Network Primary Care doctor, please contact your current CHOP specialist for more information.

My child sees a CHOP specialist in Pennsylvania. Who can I call for more information?

If your child sees a CHOP New Jersey Care Network Primary Care doctor, please contact that doctor’s office for more information.

If you child does not see a CHOP New Jersey Care Network Primary Care doctor, please contact your current CHOP specialist for more information.

My child is currently receiving physical therapy (PT) at CHOP’s Specialty Care Center in Voorhees. Can my child continue to see their physical therapist?

Your child will be able to access CHOP PT services through Nov. 30, 2020, with an existing authorization. An authorization from UHCCP NJ is required in order to be seen by CHOP PT on or after Dec. 1, 2020. UHCCP NJ may authorize continued PT care at CHOP through Feb. 28, 2021.

Please contact your child’s PCP’s office or prescribing physician to obtain this authorization.

My child has a follow-up appointment with a CHOP specialist scheduled for a date before Dec. 1, 2020. Can we keep this appointment?

Yes, you may keep this appointment. Any care on or after Dec. 1, 2020, will require authorization from UHCCP NJ. Please call UHCCP NJ Member Services at 1-800-941-4647 or the number on the back of your child’s health plan ID card for more information. 

My child is scheduled for their first visit with a CHOP surgeon before Dec. 1, 2020. Can we keep this appointment?

Yes, you may keep this appointment. Any care on or after Dec. 1, 2020, will require authorization from UHCCP NJ. Please call UHCCP NJ Member Services at 1-800-941-4647 or the number on the back of your child’s health plan ID card for more information.

My child is scheduled for their first visit with a CHOP surgeon after Dec. 1, 2020. Can we keep this appointment?

For new patient appointments on or after Dec. 1, 2020, an authorization from UHCCP NJ is required before the appointment is confirmed and for any follow-up care provided by CHOP.

Please call your child’s PCP’s office to obtain the authorization.

What insurance company can I switch to in order to stay with CHOP?

You don’t need to change your Medicaid or CHIP plan at this time to be seen by CHOP providers prior to Dec. 1, 2020.

Unfortunately, CHOP does not have a full participation agreement with any of the other New Jersey Medicaid plans. ALL New Jersey Medicaid plans will require an authorization for scheduled CHOP hospital and specialist services. Please know it is CHOP’s goal to have a full participation agreement with all New Jersey Medicaid plans.

You may also call NJ Family Care at 1-800-701-0710 for assistance in selecting a health plan that helps your child get the comprehensive, coordinated, quality healthcare they deserve. If there are no health plans that meet your child’s needs, you may ask whether your child is able to qualify for an exemption and receive New Jersey Medical Assistance. For additional information, please visit njfamilycare.org.

** CHOP CANNOT MAKE ANY SPECIFIC RECOMMENDATIONS REGARDING ALTERNATIVE NEW JERSEY MEDICAID OR CHIP PLANS! **

What are my rights?

For information about your rights as a UHCCP NJ member, please call UHCCP NJ at 1-800-941-4647 or the number on the back of your child’s health plan ID card. You can also contact New Jersey Family Care at 1-800-701-0710.

Who can I call to express my concerns about not having access to CHOP’s services?

To voice your concerns, please contact Governor Murphy’s office at 609-292-6000 or via the contact form on his office’s website.

My child has New Jersey Medical Assistance, not through a Medicaid plan. Will the UHCCP changes impact my child?

The UHCCP changes will not impact any children enrolled in New Jersey Medical Assistance. CHOP and our physicians will remain enrolled with New Jersey Medical Assistance.

We have a United Healthcare Commercial Plan (UHC) as our family’s health insurance. Will the UHCCP NJ changes impact my child’s ability to access CHOP?

No. None of the commercial plans offered by United Healthcare (UHC) are impacted by the termination of the UHCCP NJ contract.

If UHCCP NJ does not authorize my child’s care at CHOP on or after Dec. 1, 2020, may I self-pay for my child’s care?

If UHCCP NJ will not authorize care at a CHOP facility or with a CHOP specialist, we suggest that you ask them for the name of an in-network provider that would be available to provide care for your child. If the suggested provider does not meet your child’s care needs, you may file a patient grievance with UHCCP NJ or contact NJ Family Care. If you still want your child to receive care at CHOP on or after Dec. 1, 2020 without authorization from UHCCP NJ, you may pay for the services as long as you understand you are accessing care with an out-of-network provider and will be personally responsible for payment. You will be asked to sign a Notice of Insurance Information and Payment Obligations form, which will provide an estimate of your costs for the CHOP services and will acknowledge that you will be financially responsible for all charges should you choose to continue your care without authorization.


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