In cases where services are covered by UnitedHealthcare in an area that includes jurisdictions of more than one contractor for original Medicare, and the contractors have different medical review policies, UnitedHealthcare must apply the medical review policies of the contractor in the area where the beneficiary lives. LCDs are specific written policies made by the Medicare Administrative Contractor (MAC) with jurisdiction for each individual State. In the absence of an NCD, UnitedHealthcare abides by applicable Local Coverage Determinations (LCDs).UnitedHealthcare abides by Centers for Medicare & Medicaid Services (CMS) payment policies, and National Coverage Determinations (NCDs).All services rendered must be referred and authorized by the member's provider, unless specifically stated otherwise in the EOC or SOB.Covered benefits, limitations, and exclusions are specified in the member's applicable UnitedHealthcare Medicare Evidence of Coverage (EOC) and Summary of Benefits (SOB).These UnitedHealthcare Coverage Summaries are applicable to UnitedHealthcare Medicare Advantage Plans offered by UnitedHealthcare and its affiliates. Please read the terms and conditions below carefully.
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