Opt-out waiver usage requirements

July 2023

To submit an acceptable, opt-out waiver, you’ll need to meet these requirements:

• Patients need or desire: An alternate product request (APR) should be pursued when a patient wants or needs devices that are not listed on their benefit plan’s formulary before completing an opt-out waiver and conducting a private sale. The protocol for initiating an APR is to contact the Provider Care team at 855-523-9355 to request the form.
• Quote has been generated: You must generate a quote in the UnitedHealthcare Hearing Provider Portal for devices that are being recommended which will calculate the patient’s total out-of-pocket cost. If the patient chooses to opt-out and purchase privately, you must document the price from the quote on the opt-out waiver.

If any of the above parameters for acceptable opt-out waiver usage are not met, we’ll deny the opt-out waiver.

Resources

For additional information, please view the following resources: 

• Opt-out waiver protocol for Acceptable Member Opt-Out Waiver usage 
• Appendix 3 of the Provider Reference Guide