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united healthcare responses
Posted By: Ottinger, David T. on September 6, 2012
I got quite a few responses and I want to thank everyone who responded!
call your state insurance commissioner and complain-- Bob Jensen CPO
Don't stand for the denial. You have your reference # when you spoke to cust serv. All calls are recorded for education purposes..ha! We all know we can call these insurance companies with all their out sourced cust. serv. centers in India, the Phillapines, Barbados, off shore where everrrrrrrrrr..and continuously get wrong information! This really burn's me to no end's and I NEVER PUT UP W/ A DENIAL!!! I get allllllllll my claims paid. I don''t back down and I fight to the very top all the way to the Medical Director if I have to.
I call the corporate offices..ask for the Patient Advocate Dept. This is the department before the Chief Financial Officer's office. This department will look into your claim and get it paid for you. Be sure to have alllllllll your information readily available. Ref# Date and Time of Call..name of agent you spoke to and of course all the codes your billing for. They look the claim up on their systems and go to bat for you. It usually takes a good couple of weeks..but you will get paid so long as all your information is correct. Also,. mention to them that you will be sending a bill to the patient telling them that their insurance company refuses to pay their claims. That get's them working on it right away. That's the last thing they want to do is upset the patient for fear of losing thier business..hit them where it hurts..try taking a patient away from them and their almighty premiums out of theirrrrrrr pocket..you'd be surprised how fast they pay this claim. Emphesis on YOUR BILLING THE PATIENT BECAUSE UNITED REFUSES TO PAY..
Be sure to get the Pt Advocate's name and get a ref # for that call as well, time and date.
I literally have had only 1 claim in 10 years not paid from all insurance I've billed. I chew these insurance companies for lunch!..I hate them all! LOL
No matter what they say anything over $1000 needs notification. It is not really authorization. Notification is completed on their website.
What I'd do is start recording your phone calls when you call for pre-approval.
Use a check list to make sure your person asking gives them all the info they should need to make the decision.. and make sure you get the person's name at UHC. All of it, on the recorder.
Then when you get a rejection, you call back, and play the call where you asked for pre-approval.
Then (recording again) ask the person, what information should have been provided in the first call. Add that to the check list. The next time you call, use the new and improved check list.. recording each call.
Eventually you will have the definitive "manual" for pre-approval.
They will also learn that they can't play both ends against the middle for ever!
(In fact, I suspect the 2nd or 3rd time you do it, your rejection rate may go down!.. Especially if you start asking for their supervisors name and phone number!)
A product like this one might allow you to put the voice recordings right into your computer along with your other patient records..
(I know nothing about the recorder vendor or the quality of the product, it's just an example of what you might be able to use.)
I would call the Attorney General's office of your state.
I had the same thing happen several years ago and the patient was a dentist.
I called UHC and precert told me there was no authorization required, the claim would be denied due to no precert, we would send it back in and it was still denied. The UHC representative could not tell us why but she agreed with us. This went on for a year and I finally told the dentist she would have to pay for it herself, she said it was not her fault and I told her it certainly wasn't my fault and she need to take it up with her insurance company that I had done everything I knew how to do. She actually set in on two of the telephone conversations with UHC so she heard the confusion. She said she was not going to pay and I told her if she did not, since it was not my problem and I felt I had gone out of my way trying to settle this for a year, I would have to turn her over to collection. I got the money and I would assume she took it up with UHC. I do not know the outcome with UHC.
Fred Wallace, L.C.O.
Metro Orthotics & Prosthetics
united health care has their own system, it works if you understand it. you should check benefits online (unitedhealthcareonline.com), if you're not signed up you should get signed up. check deductible, check benefits. the benefit section will tell you how much they will pay in and out of network, what items are covered or not covered and if the plan has a calendar year cap for dme. the benefit section will also tell you when "notification" is required, uhc does notifications not authorizations. We are out of network so we know that notification is required for anything over $1000.00. Notifications can be submitted online if the device has less than 10 lines. Over 10 lines we have to call. It might take 2 weeks before you receive a notification answer. If you see a benefit statement that says "look at notification section above" and you don't see it (happens on some medicare plans), you'd better search the internet for benefit manual for that plan to see when notification is required. Hope this helps.
Pat, Ryder Orthopaedics
Yes, we get incorrect info from united all the time. We demand auth and if we must we call back and speak with another representative.
We have had the same problem with United for some time. We have decided our new policy for United Healthcare is to get everything in writing. If they tell us no authorization is necessary then deny the claim we will have written proof that they told us it was not needed.
John Wall PT, CPO
Wall Prosthetics & Orthotics Inc.
We have not experienced this issue. Typically, when we call for verification, I have the codes and ask specifically for each code.
If you have obtained the name of whom you spoke to, the date, and/or a reference number, I would appeal the denial using that information. We do have issues like this periodically with our Blue Cross. Typically, if you can prove that you did your due diligence in verification and that you were given the wrong information, you will win in appeals.
I have not had that problem with UHC. I do know that any codes over $1,000 must have pre-auth.
[E-mail Address Removed]
We terminated our contract with UHC due to problems like this, but more importantly due to the super low reimbursement. I encourage all providers to get out of contracts that are unreasonable. Participating with their low fees cuts their expenses, this means they can sell their product cheaper to employer groups. This helps them get even bigger and perpetuates the low reimbursement issue. We all need to stick together and stop this downward spiral. I find it interesting that at least in Michigan their fees are way below Medicare for orthotics but they pay the same as Medicare for prosthetics!
Steve Williams C.O.
You should always get a call reference number from UHC (or any other insurance company). Those calls are recorded. If you have an issue with information that was verbally given to you, call the customer service number and give them the call reference number. That has worked to our favor on numerous occasions.
I have experienced the same issues with UHCP! I have found through trial and error when billing do not use any modifiers. We were getting the same denials too and when I began submitting the claims without the modifiers the claims began to pay. Hope this helps! Amanda
Steve's response I thought was the best with recording the CSR's especially since I had just said that to my billing reps.
David Ottinger, BOCO
OSMC Orthotics Dept
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