In-network vs. Out-of-Network & Travel Issues

If an in-network provider refers me to an out-of-network specialist, how will my claim be paid?
To receive the highest benefit level, you should always attempt to seek services from a network provider. 

If you travel to a different location for a few months, how do you avoid out-of-network charges?
If you are traveling for part of the year, you may want to contact the Caterpillar Benefits Center for a temporary address change to receive mail at this address. This temporary address change will not impact your network requirements or place you in a different network plan. If you are in a network plan, contact your plan administrator (UHC) or visit UHC's website/use their mobile app to find network providers in that area to receive the highest benefit level. 


How is Out-of-Network handled when someone is traveling or on vacation?
When traveling for the company or on vacation and medical care is needed, office-based services for a non-emergency situation are payable at the In-Network level. Hospital services for non-emergency situations are subject to Plan guidelines and payable at the Out-of-Network level unless a network hospital is used. Contact UHC if you feel you claim was not properly considered as outlined above.

UHC network participants are required to use a network physician to receive the highest benefit level. Use of a non-network hospital for non-emergency care will be processed at the Out-of Network level.


If someone is injured while out-of-network, will the emergency benefit still cover at in-network amounts?

Yes. The in-network co-insurance levels still apply when an emergency situation happens out-of-network. We follow the same definition of “emergency” as defined by UHC. Definition of true emergency: Sickness or injury that could be life-threatening or cause serious harm to the patient's bodily functions such as apparent heart attacks, severe bleeding, loss of consciousness, convulsions, fractures, severe or multiple injuries.