I live in California and I had the UHC Choice Plus HSA insurance (at the time of visit) through my employer. Some time around last October, I got into a bike crash and had to be taken to the ER of an in-network hospital. However, the surgeon on-call who came to treat my wounds is out-of-network for my insurance. Because of that, I was told by the surgeon’s office that I would have to pay the full amount to the surgeon and ask for a reimbursement from UHC, so I paid the full amount upfront. The surgeon’s office also confirmed that because I was treated at an in-network hospital, the claim would be processed as an in-network visit. It has been 9 months (and multiple follow-up calls with UHC and surgeon’s office) since the incident and this is the current status:
On the UHC portal, the claim shows as an out-of-network visit The surgeon’s office says that their claim has been denied UHC says it is waiting for missing documentation from the surgeon’s office (doesn’t mention anything about the claim being denied)
At the time of ER visit, the surgeon said that they haven’t had any issues with processing such claims earlier, but now I am really confused about this. All I did was visit an in-network ER, but now I am stuck dealing with this out-of-network confusion. Is there a possibility that UHC eventually denies the claim? What are my options if UHC denies it or processes it as an out-of-network claim?
submitted by /u/prawncream
[link] [comments]
I live in California and I had the UHC Choice Plus HSA insurance (at the time of visit) through my employer. Some time around last October, I got into a bike crash and had to be taken to the ER of an in-network hospital. However, the surgeon on-call who came to treat my wounds is out-of-network for my insurance. Because of that, I was told by the surgeon’s office that I would have to pay the full amount to the surgeon and ask for a reimbursement from UHC, so I paid the full amount upfront. The surgeon’s office also confirmed that because I was treated at an in-network hospital, the claim would be processed as an in-network visit. It has been 9 months (and multiple follow-up calls with UHC and surgeon’s office) since the incident and this is the current status:
On the UHC portal, the claim shows as an out-of-network visit The surgeon’s office says that their claim has been denied UHC says it is waiting for missing documentation from the surgeon’s office (doesn’t mention anything about the claim being denied)
At the time of ER visit, the surgeon said that they haven’t had any issues with processing such claims earlier, but now I am really confused about this. All I did was visit an in-network ER, but now I am stuck dealing with this out-of-network confusion. Is there a possibility that UHC eventually denies the claim? What are my options if UHC denies it or processes it as an out-of-network claim?
submitted by /u/prawncream [link] [comments]Read Morer/HealthInsurance