We always begin the billing process with verification of benefits on a patient's plan. I ask very specific questions from learning that the provider and patient are screwed if not detailed.
For example- We are out of network, are there out of network benefits. Do we need Pre-Authorization, certification or notification to receive the stated benefits. Is there any Pre-Existing on this plan?? We verify the deductible amounts, the limits/max of services allowed per year or time period, co-insurance amounts and if anything has been met or used.
So with this case, I specically asked these questions and all the services were covered. I received a confirmation number as well so I could refer back if needed. A portion of the $1,000 deductible was met which means we must pay attention to how much they calculate towards our services. We begin to bill the services back in November and December 2012.
Notices/explanation of benefits from UHC state that certain services are being covered and calculated towards the deductible but many other services are not covered under the patients plan. So, I call in December and review all of the benefits again and receive the same info. that all of the services are covered. The staff at uhc sends all claims back for review.
I continue to receive denials and call again in late December. I speak to a supervisor who also states all of the services are covered and he resubmits all of the denied codes. Then in January 2013, UHC requests that we return some payment because of their miscalculations. Now, I am reviewing the deductible and find that they are charging us the entire $1,000 deductible even though $115.26 had been met prior to us billing.
Once again, I call UHC and ask them to recalculate amd resubmit, but instead, they take the money from another patients check since I did not reimburse them?? We finally appeal by letter to UHC appeals department and after a month they do not really have a clear response, letter states corrective steps are needed?? Next we receive 4 letters requesting that we return more money to them as none of the services are covered on his plan??? I review each claim online and discover that they are denying every single services stating that it is not a covered service on the patient's plan???
I again call UHC and it takes 4x to actually get to speak to a supervisor after 4 HOURS of on hold or getting disconnected.(?@#@???#@) It is always someone different and non of them have direct lines --I believe this helps UHC because patients and doctors offices just give up. The supervisor reviews all of the benefits again and states that yes, all of the services should be covered per the benefits he sees and states he is resubmitting again with a copy of the benefits. He states that another resolution specialist should be calling within 2 days. She calls and sees that this case is a huge mess but she cannot resubmit since the appeals department denied all of the services.
She must contact a customer advocate to help try to correct this mess. Of course, she does not have a phone to contact either. She will just get back to me in about a week or so. Here we are in August 2013, still dealing with his claims from late 2012.
I am so disgusted with UHC. This is shameful!
I have no respect for this company and their obvious goals of running over their customers and the doctors offices that serve them.
Review about: United Healthcare Claim.
Monetary Loss: $500.