Frequently Asked Questions and Answers

Frequently Asked Questions and Answers The frequently asked questions are organized by the following categories: Contract Access FAQs Enrollee FAQs Physician, Facility & Health Care Professional FAQs CONTRACT ACCESS FAQs: Q1: In general, what is happening and when? A1: Some of the customers of Midwest Security Life Insurance Company, a wholly owned subsidiary of UnitedHealth Group (the parent company of UnitedHealthcare), began accessing the UnitedHealthcare Options PPO facility and physician network for the Midwest Security product in Wisconsin on June 1, 2006. Midwest Security s customers are being notified of this opportunity via modified proposal documents that reference the UnitedHealthcare Options PPO network, including UBH and ACN Group. Customers will access listings for the UnitedHealthcare Options PPO network through an Online Provider Directory link on the Midwest Security web site, www.midwestsecurity.com. Please note that some Midwest Security customers will continue to access other, non-unitedhealthcare networks. A given enrollee will access only one primary network the UnitedHealthcare Options PPO network is not being stacked with other networks. Some customers of TPA Midwest Security Administrators, a sister company of Midwest Security Life Insurance Company, are also accessing the UnitedHealthcare Options PPO network. Q2: Is the Provider Nomination process the same for UnitedHealthcare, ACN Group, and UBH physicians/health care professionals? Can the physician or health care professional use the same forms and contact information? A2: Yes, the physician or health care professional can use the same form for UnitedHealthcare or UBH physicians and health care professionals. For UnitedHealthcare, the enrollee or the physician/health care professional should call the VETTS phone line (877-842-3210). Select the following prompts: Healthcare Professional Services, Credentialing, Request for Participation. Once the caller selects the Request for Participation prompt, they will be connected to a Customer Service Representative (CSR) who will advise if UnitedHealthcare is adding new physicians/health care professionals in that specialty and market service area. For UBH physicians or health care professionals, an enrollee can either use the same UnitedHealthcare form and process described above, or the physician/health care professional can contact the UBH Network Manager for their state to discuss it. A list of UBH Network Managers can be found at www.ubhonline.com. For ACN Group, the physician/health care professional should contact ACN Group directly at 800-873-4574. Enrollees may nominate a physician/health care professional for inclusion in the ACN Group network by contacting ACN Group directly at 800-873-4574. Page 1

Nomination for addition to the UnitedHealthcare, UBH and/or ACN Group is not a guarantee that the particular physician/health care professional will be added to the network. UnitedHealthcare, UBH and ACN Group make every effort to provide balanced network access for all enrollees. Q3: Are ACN Group (formerly American Chiropractic Network) and UBH owned by UnitedHealthcare? A3: ACN Group and UBH are under common ownership with UnitedHealthcare all three companies are part of the family of companies owned by UnitedHealth Group. ENROLLEE FAQs Q1: How do I find a physician/health care professional in the UnitedHealthcare, UBH, or ACN Group network? Do I use the same web site as for Midwest Security Life Insurance Company? A1: All participating physicians/health care professionals can be located through the Midwest Security website, www.midwestsecurity.com. Choose Online Provider Directory from the main menu and, if your benefit plan uses the Options PPO network, select the Options PPO option. In the Options PPO lookup window that opens, you can select the Mental Health & Substance Abuse Providers for a listing of UBH physician/health care professional or select ACN Providers for a list of Chiropractors and CAM (Complimentary Alternative Medicine) physicians/health care professionals. Q2: Can I assume that if a physician/health care professional is listed on the website that it is a participating physician/health care professional? A2: Yes, the participating physicians/health care professionals of the national UnitedHealthcare Options PPO network, ACN Group network, and the UBH network will be listed. Q3: What card should be presented when seeing an ACN Group or UBH doctor? A3: Midwest Security enrollees will get a new card displaying the UnitedHealthcare logo and this same card should be used when accessing the ACN and UBH network. Separate ID cards are not necessary for chiropractic and mental health/substance abuse network access. Q4: What if there is no ACN Group or UBH physician/health care professional in my area? How do I nominate a physician/health care professional to apply to join the network? A4: Midwest Security enrollees can nominate physicians and health care professionals to ACN Group and UBH by using the standard nomination form. We cannot guarantee that the nominated physicians/health care professionals will be added to the network, but we will certainly consider them. For UBH physicians/health care professionals, an enrollee can call the VETTS phone line (877-842-3210) and select the following prompts: Healthcare Professional Services, Credentialing, Request for Participation. Once the caller selects the Request for Participation prompt, they will be connected to a Customer Service Representative (CSR) who will advise if UnitedHealthcare is adding new physicians/health care professionals in that specialty and market service area. A physician/health care professional can contact the UBH Network Manager for their state to discuss it. A list of UBH Network Managers can be found at www.ubhonline.com. Page 2

For ACN Group, the physicians/health care professionals should contact ACN Group directly at 800-873-4574. Enrollees may nominate a physician/health care professional for inclusion in the ACN Group network by contacting ACN Group directly at 800-873-4574. Nomination for addition to the UnitedHealthcare, UBH, and/or ACN Group network is not a guarantee that the particular physician/health care professional will be added to the network. UnitedHealthcare, ACN Group and UBH make every effort to provide balanced network access for all enrollees. Q5: What is the CAM program offered by ACN Group? A5: Complimentary Alternative Medicine (CAM) is also known as United Naturally. This is a discount program that allows enrollees to see a CAM physician/health care professional and receive a discount up to 20% for the service provided. CAM physicians/health care professionals include Massage Therapists, Dieticians, Naturopaths, and Acupuncturists. The physician/health care professionals are credentialed by ACN Group. Please note CAM is NOT an insurance program, so there are no claims generated to UnitedHealthcare. The enrollee must pay for their visit upon completion of service. Q6: When I go to the Online Provider Directory, the physician has a star by his/her name. What is that star indicating? A6: UnitedHealthcare, the parent company of Midwest Security Life Insurance Company, offers a program called the UnitedHealth Premium program. A physician s/health care professional s participation in this program is denoted with a star symbol. Midwest Security is not participating in this program at this time. The UnitedHealthcare network available to Midwest Security enrollees includes those physicians/health care professionals listed with stars and also includes those physicians/health care professionals listed without stars. PHYSICIAN, FACILITY & HEALTH CARE PROFESSIONAL FAQs: Q1: Why am I receiving a different payment for this claim than I did in the past when the same services were rendered? A1: As a result of Midwest Security becoming a wholly owned subsidiary of UnitedHealth Group (the parent company of UnitedHealthcare), some Midwest Security enrollees are now accessing the UnitedHealthcare network and payment is calculated according to your UnitedHealthcare contract. Prior to June 1, 2006, claims were paid under a Midwest Security leased network arrangement; subsequent claims may be paid under the UnitedHealthcare contracted rate. Q2: What contract did you use to process the claim? A2: You are reimbursed based on your UnitedHealthcare contract. Q3: My facility does not have a UnitedHealthcare contract to participate in the network. Why did you price this claim according to UnitedHealthcare? A3: Our records indicate your organization is currently contracted with UnitedHealthcare. If you want to confirm your participation or have further questions, please call 877-842-3210. Q4: My UnitedHealthcare contract has more than one rate for commercial products. Which rate did you use to process the claim, and why? A4: If the enrollee s card indicates Options PPO, you are reimbursed at the same rate that is used when you provide services to enrollees in UnitedHealthcare s Options PPO product Page 3

because the in-network and out-of-network benefits and other features of the Midwest Security Life Insurance Company Select Coverage benefit plan supports the Options PPO rate structure for this enrollee. Q5: Will all my Midwest Security claims be paid this way? A5: Reimbursement is dependent on the enrollee s benefit plan in place at the time of service. All Midwest Security benefit plans that access the UnitedHealthcare network will be paid at the UnitedHealthcare rate. Some Midwest Security benefit plans will access networks other than the UnitedHealthcare network, and those claims will be paid according to the physician s/health care professional s arrangement with those networks. Q6: I don t agree with how you paid my claim. A6: Is your concern about the contracted rate or how the benefits were applied? The Customer Service Representative can respond to any benefit plan questions. The Customer Service Representative can forward contract pricing questions to UnitedHealthcare network management for review and their response to you with an update. Q7: For what is the patient responsible? A7: Patient liability is determined by the patient s benefit plan with Midwest Security. If your patient has any liability, it will be noted on your physician/health care professional remittance advice. The patient will also receive an Explanation of Benefits (EOB) that will show their liability. Q8: As a facility, are we obligated to accept this discount? A8: Yes. Your organization was reimbursed according to your UnitedHealthcare contract. Q9: Do plan benefits impact the claims payment? A9: Yes. As always, the payment actually made by us is determined by both the contract rate agreed to between you and UnitedHealthcare and the enrollee s benefit plan. Q10: I disagree with the contracted rate. Who can I [facility representative] speak to at UnitedHealthcare about how the claim was paid? A10: The Customer Service Representative will first review the claim payment to ascertain what your specific questions are and help you with benefit related issues. If your issue is related to the contracted amount(s) applied, the Customer Service Representative will refer your inquiry to UnitedHealthcare for response. The claim stands as is until UnitedHealthcare responds with any changes. If you have further questions, please call 877-842-3210. Q11: When will new ID cards be issued to Midwest Security enrollees? A11: New ID cards with the UnitedHealthcare logo are issued upon purchase of the applicable Midwest Security benefit plan, beginning with June 1, 2006 and future dates. Midwest Security ID cards reflect the applicable network arrangement. No Midwest Security enrollees will be given access to the UnitedHealthcare network before being given an ID card reflecting that access. Q12: Who is processing these claims - UnitedHealthcare or Midwest Security? Do I start sending all my UnitedHealthcare claims to Midwest Security? A12: All claims facility or physician - should be mailed to the address noted on the enrollee s ID card. That way, you will be sure to get the claim to the correct location for processing and there will not be any delays. If you submit claims electronically, please follow the routing Page 4

information shown on the enrollee s ID card. Midwest Security is processing claims for Midwest Security enrollees, and is utilizing the UnitedHealthcare network of physicians/health care professionals. Q13: Our facility s contract with UnitedHealthcare has more than one contract rate. Which rate are you using to pay my claims, and why? A13: Reimbursement is dependent on the enrollee s benefit plan in place at the time of service. All Midwest Security benefit plans that access the UnitedHealthcare network will be paid at the UnitedHealthcare rate. Some Midwest Security benefit plans will access networks other than the UnitedHealthcare network, and those claims will be paid according to the physician s/health care professional s arrangement with those networks. Q14: Do the ACN Group Clinical Support rules apply? A14: Midwest Security enrollees will have network access only for ACN Group physicians/health care professionals. The Clinical Support guidelines will not apply. Q15: Why is there a logo for a secondary network on the back of the enrollee s card? A15: Midwest Security enrollees have a new feature available: Shared Savings. In anticipation of this new feature, the logo for the secondary network was placed on the enrollee s ID card. Enrollees are encouraged to seek services from a UnitedHealthcare network participant to maximize their plan benefit options. If they do not use the UnitedHealthcare network, they may enjoy other savings through the Shared Savings program. Q16: Where should I send my claims? A16: In order to not delay the processing of your claims, you should continue to send claims for Midwest Security enrollees to the address shown on the back of the enrollee s ID card. Page 5

<Insert Date> <First_Name>, <Last_Name> <Adr_Street> <Adr_City> <Adr_State>, <Adr_Zip><Adr_Zip_Plus4> Dear < First_Name> < Last_Name>, <M.D.>, Midwest Security Insurance Companies became a wholly owned subsidiary of UnitedHealth Group, UnitedHealthcare s parent company, in October 2002. We are pleased to announce that Midwest Security s insured Wisconsin clients can now select UnitedHealthcare s hospital and physician network for dates of service on or after June 1, 2006, enabling greater flexibility and expanded choices for Midwest Security enrollees. It also means a potential increase in your volume of business because their enrollees will be able to access your office for services on an in-network basis. Midwest Security enrollees accessing UnitedHealthcare s network will receive new ID cards that will include the UnitedHealthcare logo. The enrollees eligible for in-network care from physicians and facilities participating in the UnitedHealthcare network will have access to the UnitedHealthcare Directory of Physicians and Health Care Professionals. These enrollees will incur lower out-of-pocket costs when receiving in-network services. Here is a sample medical ID card (front and back): Policies and Procedures The policies, procedures, and protocols you currently follow when treating UnitedHealthcare enrollees will apply when treating Midwest Security s enrollees who access the UnitedHealthcare network. Please refer to the 2006/2007 UnitedHealthcare Administrative Guide for physicians, facilities and other health care professionals for further information. The guide, as well as UnitedHealthcare s policies and procedures, are available at www.unitedhealthcareonline.com. Reimbursement Please remember that, in accordance with your UnitedHealthcare participation agreement, when you treat eligible Midwest Security enrollees who access the UnitedHealthcare network it will be on an in-network basis subject to UnitedHealthcare s policies, procedures, protocols, and contract terms. The appropriate payment rates under your existing UnitedHealthcare participation agreement will be applied to claims for Midwest Security enrollees. UnitedHealthcare can provide you with consistent and predictable reimbursement for your services to these covered individuals.

Claims Claims for services provided to Midwest Security enrollees should be submitted to the address on the back of the patient s medical ID card. Midwest Security Insurance Companies P.O. Box 266 Onalaska, WI 54650-0266 Our relationship with you is very important and we value your participation in our network. We are excited about the access that an integrated network will provide both you and your patients. If you have any questions about administering claims for this expanded customer base or the information presented here, please call Midwest Security at 800-542-6640. Sincerely, UnitedHealthcare Network Management