Columbia United Providers

Family Planning	Dialysis	Lab and X-ray Services
Home Health Care	Surgery	Oxygen/ Respiratory Services
Well Baby Care	Speech Therapy	Medical Equipment
Well Child Care	Hospice Care	Pharmacy/ Prescription
Well Adult Care	Organ Transplants	Blood Transfusions/ Products
Immunizations	Office Visits	Eye Exams
Radiation Treatment	Occupational/ Physical Therapy
Non-emergent Hospital Care (must be pre-approved by CUP. Talk to your PCP about getting approval.)
Health education for diabetes and heart disease
Smoking cessation for pregnant women
Urgent Care
Specialty Care and Consultations, with approved referral from your PCP
Ambulance (for emergencies or approved medical transportation)
Maternity Care: Your doctor and you decide on how long you and your baby can stay in the hospital after your child is born

What services are limited by CUP? [Back to Top]

TRANSPLANTS include the following:

Bone Marrow	Heart-Lung	Pancreas
Kidney	Liver	Heart
Lung	Comea	Peripheral Blood Stem Cell

• ROUTINE VISION CARE includes an eye exam and a refraction every 24 months for adults age 21 and older and once every 12 months for children age 20 and younger. You do not need a referral from your PCP if you see a CUP network provider. See your Provider Directory for a list of network providers.

Call our Member Service Department at (360) 891-1520, (800) 315-7862, or TDD (360) 449- 8860, Toll Free TDD (866) 287-9962, if you need help. Our office is open Monday-Friday, 8 a.m. - 5 p.m.

NOTE: Eye exams required for medical conditions are not included in this limitation. Medical eye exams need to be referred by your PCP.

• OUTPATIENT MENTAL HEALTH services are limited under your Healthy Options plan. You may be referred to a CUP Provider or to the Regional Support Network (RSN). Contact your PCP or ProBehavioral Health toll free at (800) 611-9067 for help deciding where to get your treatment.

When approved, CUP will cover:

Psychological testing and evaluation once every 12 months for adults and as often as needed for children under age 20 when ordered by the PCP.
Up to 12 hours of treatment per calendar year and unlimited medication management when provided by the PCP.

• CHIROPRACTIC SERVICES are only covered for children, age 20 and under, when they are referred by a PCP because of an EPSDT screening.

• PHARMACY MEDICATIONS and OVER THE COUNTER PRODUCTS are limited to the approved drugs on the drug list. The use of generic drugs is required when available. Prescriptions can only be for 30 days and refilled on a monthly basis with orders from your doctor.

• STERILIZATION is covered by CUP for members over age 21. CUP members must wait 30 days after you sign the consent form before sterilization can be done. Sterilization is covered by the DSHS Medical ID Card only for members age 20 and under.
• NUTRITIONAL COUNSELING is covered for specific conditions such as diabetes, high blood pressure, and anemia, or if medically necessary for a child.

• ROUTINE SCREENING MAMMOGRAMS are covered yearly for women age 40 and over.
• ROUTINE WOMEN’S BREAST AND PELVIC exams with pap smears are covered once a year.

• ROUTINE PHYSICALS FOR ADULTS AGE 21 and over are covered every 2 years.
• GENETIC COUNSELING when medically necessary.

• RECONSTRUCTIVE SURGERY is limited to the following:

Breast Reconstruction after a mastectomy. This includes reconstruction of the other breast to produce an even appearance.
Correction of a disorder resulting from congenital disease, anomaly, or injury.

• FOLLOW-UP CARE must be provided or pre-approved by your PCP before care is given. Talk to your PCP before you get follow-up care.

• EXPERIMENTAL AND INVESTIGATIONAL TREATMENT OR SERVICES, and any services associated with services that are experimental or investigational. Experimental and investigational services are new or still in testing stages. CUP has a group of doctors who review new services to decide if they are medically necessary and beneficial for CUP members.

ALL SERVICES MUST BE MEDICALLY NECESSARY. ALL DRUGS MUST BE FDA APPROVED. ONLY SERVICES AND DRUGS COVERED UNDER THE DSHS FEE-FOR-SERVICE PROGRAM ARE COVERED BY CUP.
If you do not understand these limited benefits or you want to ask questions, call the CUP Member Service Department at (360) 891-1520, (800) 315-7862, TDD (360) 449-8860 or Toll Free TDD: (866) 287-9962.

What services does my DSHS medical coupon cover? [Back to Top]

Some benefits are ONLY covered by your DSHS Medical ID card and are NOT covered by CUP. You must use your DSHS Medical ID card to get these services and find a provider who will bill DSHS for payment. Some of these services are available to you through your local community mental health center, health department or family planning clinic. Call DSHS Customer Service at (800) 562-3022 or TTY (800) 848-5429 for more information.
• Dental care with limited orthodontics
• Eyeglasses and fitting services
• Genetic counseling (prenatal only)
• Hearing aids
• Interpreter services for medical visits at no cost to you
• First Steps Services such as Maternity Support Services and Infant Case Management
• Mental health services (Inpatient psychiatric care, Outpatient services at Regional Support Networks or Community Mental Health Centers and medication management)
• Neurodevelopmental services at DSHS approved centers
• Sterilizations when under age 21
• Substance abuse services including Detox for alcohol and drugs
• Voluntary pregnancy terminations
• Nursing facility and community based services covered by the Aging and Disability Services Administration
• Services covered through the Division of Developmental Disabilities
• Infant formula covered by the WIC program
• School medical services for students with special needs
• Protease inhibitors
• Gastroplasty, when approved by DSHS
• FREE transportation for medical appointments through the Medicaid Transportation Brokerage (1-800-752-9422)

IMPORTANT! You have the right to get the following services from your PCP or you may choose to get these services at your local Health Department, Community Mental Health Center, or Family Planning Clinic.

Immunizations (Shots)
HIV & AIDS Testing
TB Screening & Follow-up care
Sexually Transmitted Disease treatment and follow-up care
Family Planning Services and birth control by calling the Family Planning Hotline: (800) 770-4334
Women, Infants, and Children (WIC) program

Note: the WIC program is only available from the local health department

What Services Are Not Covered? [Back to Top]

The following services are NOT COVERED by either CUP or your DSHS Medical ID Card. If you choose to have one of the following services, your provider will ask you to sign an agreement to pay. This agreement to pay says you are responsible for payment of the service.
• Products, services and supplies related to sex transformations
• Medical examinations for Social Security disability benefits
• Circumcisions, except when medically necessary
• Cosmetic services: services for which plastic surgery or other services are indicated primarily for cosmetic reasons
• Physical examinations required for obtaining or continuing employment, sports, insurance or governmental licensing
• Reversal of voluntary, surgically-induced sterilization
• Personal comfort items, including but not limited to guest trays, television, and telephone charges
• Biofeedback therapy
• Diagnosis and treatment of infertility, impotence, and sexual dysfunction
• Orthoptic (eye training) care for eye conditions
• Tissue or organ transplants other than those specifically listed as covered
• Immunizations required for international travel purposes only
• Court-ordered services
• Any service provided to a member while in jail
• Chiropractic services for adults age 21 and older
• Any other service, product, or supply not covered by MAA under its fee-for-service program

If you have any questions about covered services, please call our Member Service Department at (360) 891-1520, (800) 315-7862, TDD (360) 449-8860 or Toll Free TDD (866) 287-9962.