Tier 1 Providers and Freestanding Facilities

The Tier 1 Designation Program Offers the Best Combination of Cost and Quality

 
UHC Tier 1 doctors:

• Have better clinical results
• Follow evidence-based guidelines for care
• Are more likely to be aware of the latest research and clinical trials
• May have lower surgical revision rates

UHC designates Tier 1 providers for 16 Premium specialties and 47 sub-specialties, and re-evaluates them on an annual basis. These providers are determined by using actual claims data to identify doctors who demonstrate greater quality of care and cost efficiency. UHC assesses quality first, then cost.

The quality standards are based on evidence-based medicine and guidelines from organizations such as the American College of Cardiology, Ambulatory Care, Quality Alliance and the Agency for Healthcare Research and Quality (a division of the U.S. Department of Health & Human Services).The cost efficiency standards are based on local market benchmarks for the efficient use of resources in providing care.

Look for the Tier 1 designation whenever you need a new provider. The availability of Tier 1 providers varies by location. UHC assigns the designation only where there is enough claims data to determine quality and cost efficiency. A Tier 1 provider may not be available for the specialty you need.

Freestanding Facilities Save You Money

In health care, higher cost doesn’t always mean higher quality. When your doctor prescribes lab tests, X-rays, MRIs, CT Scans or minor outpatient procedures, receive services at a Freestanding Facility instead of a hospital or doctor’s office for the lowest cost. A Freestanding Facility is an outpatient, diagnostic or ambulatory center or independent laboratory in the Choice Plus network that performs services and submits claims as a freestanding entity and not as a hospital. This can save you hundreds (and sometimes even thousands!) of dollars, without sacrificing quality.