Paid Full Retail, Claim Shows Differently

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I have United Healthcare through my employer, in Florida. Not sure if I chose the right flair.

I was prescribed a series of medications by an allergist, which totaled just over $300. I’m not sure what happened at the pharmacy, but there was no insurance indicated and I was charged full price. The medications initially did not show up at all on my UHC portal. I explained the situation to UHC’s customer support and was told to submit a reimbursement form, which I did, with the pharmacy receipts.

I was checking my account later on and noticed that the medications were added to my claims history, but the breakdown of what I paid and what UHC paid is completely off-base. According to the portal, I paid ~$70, about $240 short. I submitted a new inquiry into the claim and received this response:

When you submit a paper claim to us, we process it based on our contracted rate with the pharmacy. This may result in a reimbursement that is less than what you were charged by the pharmacy.

The form I completed says this on the top:

Use this form to request reimbursement for covered medications purchased at retail cost. Complete one form per member.

Which to my understanding, is exactly what I needed. Is my understanding wrong or do I have next steps to recoup the $240?

submitted by /u/the_real_sardino
[link] [comments]
I have United Healthcare through my employer, in Florida. Not sure if I chose the right flair. I was prescribed a series of medications by an allergist, which totaled just over $300. I’m not sure what happened at the pharmacy, but there was no insurance indicated and I was charged full price. The medications initially did not show up at all on my UHC portal. I explained the situation to UHC’s customer support and was told to submit a reimbursement form, which I did, with the pharmacy receipts. I was checking my account later on and noticed that the medications were added to my claims history, but the breakdown of what I paid and what UHC paid is completely off-base. According to the portal, I paid ~$70, about $240 short. I submitted a new inquiry into the claim and received this response: When you submit a paper claim to us, we process it based on our contracted rate with the pharmacy. This may result in a reimbursement that is less than what you were charged by the pharmacy. The form I completed says this on the top: Use this form to request reimbursement for covered medications purchased at retail cost. Complete one form per member. Which to my understanding, is exactly what I needed. Is my understanding wrong or do I have next steps to recoup the $240?
submitted by /u/the_real_sardino [link] [comments]Read Morer/HealthInsurance

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