Finding a Tier 1 Provider
Choosing the right provider is an important part of getting the best results from surgery. That’s why our plan uses the UnitedHealth Premium® Program, which evaluates providers using national quality and cost of care standards.
Providers are evaluated on:
- Quality of care
- How efficiently care is delivered
- Overall cost of care
Providers who meet these standards earn the Tier 1 designation. This means they have met criteria for delivering care that is safe, effective, and cost-efficient.
To find a Tier 1 provider, search the UHC Choice Plus Premier Network for High Option members in our provider directory. In your search results, look for providers marked with the Tier 1 Provider designation. These providers appear at the top of the results when available. If no Tier 1 providers appear, try expanding your geographic search area.
For assistance locating a Tier 1 Provider, call us at 888-438-9135 from 8 a.m. to 8 p.m. ET, Monday–Friday.
What's Covered
The enhanced surgical benefit under the High Option plan applies to certain joint replacements, heart procedures, and spine surgeries. Examples include:
- Joint replacements of the shoulder, hip, or knee
- Heart procedures such as pacemakers, defibrillators, valve surgeries, coronary artery bypass grafts, or cardiac ablations
- Spine surgeries such as laminectomies or fusions
To confirm whether a procedure is covered, call 888-438-9135 from 8 a.m. to 8 p.m. ET, Monday–Friday.
When these surgeries are performed by an in-network Tier 1 provider, the following are covered at no cost to you:
- In-network facility fees
- In-network Radiology, Anesthesiology, Pathology, and Lab charges linked to the surgery date
- In-network professional services on the day of surgery
What's Not Covered
The benefit does not apply to:
- Office visits before or after surgery
- Pre-op or post-op care on different dates
- Scans or diagnostic tests done outside the surgery date
- Other procedures performed on different dates of service
- Surgical procedures not listed in the What’s Covered section above
- Bariatric or transplant surgeries through Optum® Centers of Excellence
All benefits are subject to the definitions, limitations, and exclusions set forth in the FEHB Plan Brochure.
