Pre-authorization is not required for any procedure. If you have questions about whether your benefit plan covers a treatment, consult your Benefit Plan book or myuhc.com account. The only situation where a call prior to procedure is recommended but not required is if the treatment could be considered cosmetic in some circumstances but a medical necessity in others. A call to the UHC Customer Service Center number for ISEs, 866-230-8317 would be in order to clarify the benefit prior to treatment.

4. Why does UHC calculate the exchange rate on the date of service rather than the date of payment?

Industry standard dictates that all healthcare charges are considered based on the date services were rendered. Since the exchange rates are so variable the consequences of calculating it on the date of service versus the date of payment would be unpredictable and may not always result in a more positive outcome for the ISE one way or the other.

In addition, since the exchange rate is based on date of service, benefits remain unaffected by delays in filing or claim payment. Thus, all expenses for a particular service date are reimbursed using the specified exchange rate. This ensures consistency in the process.

5. Why is proof of payment necessary? Doesn’t Caterpillar trust us to submit claims honestly?

Proof of payment is a universal requirement for UHC to submit reimbursement to covered members. It is not an indication of lack of trust for employees, retirees or providers.

UnitedHealthcare is Caterpillar’s fiduciary agent in processing of health care and dental claims. This means UHC takes responsibility for making sure claims submitted are paid appropriately and according to the Cat plans. Proof of payment is a key factor in assuring this accuracy.

Cat and UHC recognize that proof of payment comes in different forms in different countries (i.e.- credit card statements, handwritten receipts, etc.) and in some cases may simply not be available. As part of ongoing efforts to improve the process for international claims, both Cat and UHC are working on a solution for situations when proof of payment is simply not available.

6. Why can’t all reimbursements be direct deposited? For ISEs, only the healthcare is direct deposit.

Reimbursements for health care expenses are direct deposited into the ISE accounts. When UHC first assumed claims administration in August of 2002, this capability was not in place, but recent upgrades now allow for the direct deposit from UHC medical. If you did not provide authorization for UHC to do electronic funds transfer (EFT) during implementation, you can do so at any time by contacting the ISE Health Claim Assistance e-mail.

7. UHC doesn’t recognize the dental codes used in the country in which I’m living. Will there be any resolution to this?

Due to the global variations in dental record keeping, UHC cannot systematically process all dental codes from all countries. In order to ensure that international dental claims receive the special handling that is required, it is important that all international dental claims be directed to the attention of Mita Dhora who is the UHC dental contact for international claims.

UnitedHealthcare Dental

Attn: Mita Dhora, Claims Unit

3 Irvington Center

800 King Farm Boulevard

Suite # 600

Rockville, MD 20850

8. What is Caterpillar doing to ensure UHC performance will improve for international claims?

UnitedHealthcare and Caterpillar are working on a number of 6 Sigma projects to improve the international claims filing process. Current process improvements that are being tested with a select group of ISEs include:

Once the ISE test group, Caterpillar and UHC are satisfied as to the effectiveness of the new elements, the new process will be communicated to all US ISEs.

9. UHC asked me to send x-rays in the mail. Do we have to do that? Isn’t that extreme?

10. Can UHC send an e-mail to ISEs when their claims are received?

11. Could there be a local number within our host country for UHC? ISEs have incurred excessive phone bills from waiting on hold to talk with the UHC Customer Service Representatives.

12. My child is covered but lives back in the US while going to college. Can I get a UHC ID card for him?

ID cards are issued under the employee’s name for both the employee and the spouse. However, if you have an adult child living at a separate address at college, ID cards with their name on them can be ordered by calling the UHC Customer Service Center or from myuhc.com.

13. What is the process for Flexible Spending Accounts? Sometimes I’m paid automatically and sometimes I have to mail receipts to UHC.

Ideally, claims that arrive into UHC’s regional mail office are entered and processed into the UHC claim payment system within 10 business days. The completion of electronic fund transfer takes 72 hours following processing. High dollar claims and claims requiring translation may take longer for processing. To ensure that high dollar claims are processed correctly, please provide a full itemization of the expenses incurred to include any supporting documentation (i.e. operative notes, hospital notes).

Return the payment to UHC at the address on the back of your ID card with a copy of your Explanation of Benefit including your explanation of the overpayment.

16. Why does UHC require we paper clip our documents rather than staple? Doesn’t that increase the likelihood of documents becoming separated and lost within their vast system?

17. What exchange rate does UHC use when calculating reimbursement for claims? Credit card rate? Flat rate? Paper rate? Inter-Bank rate?

The reimbursement is currently made b y UHC to Caterpillar for deposit into the ISEs U.S. bank account where their paycheck is also deposited. This is the same process used for all employees who require reimbursement for claims. This process is no different than it was prior to implementation of UHC.