Hi all, firstly I am thankful this forum exists, as I am extremely frustrated with UHC and have no idea what the truth is or how/if we can fight this. I even called a few lawyers (just seeking a 1hr consult) and can’t find anyone who works insurance legality.
My wife and I had our first child 9/23 and were in the hospital 9/23-9/25. Everything goes through my employer’s health plan and that is the only insurance we have. It is a HDHP through UHC.
Prior to our child’s birth we had met our deductible and were about $500 away from our OOP max. I read that services get billed to the mother until +3 days after the baby is born. Therefore we were expecting $500 OOP for the whole hospital visit.
We knew that after 9/26, we’d be on the hook for the higher family plan deductible and OOP for anything else for the year. The baby was added to the plan (making it a “family plan”) 10/22, within the 30 days required by insurance.
However I noticed on UHC’s site they’re not paying for some of the services rendered while we were in the hospital. I called them and they said any claim PROCESSED after 10/22 (when baby was added) applies to the new higher deductible and OOP max. Naturally, most of the claims were processed 10/25, one day after adding the baby (coincidence?)
This seems like a conflict of interest to me, as UHC would have incentive to delay processing claims until after the deductible/OOP have been raised. It seems to me it should go by date of service, which is how all other insurance works to my knowledge (“date of loss” for home insurance, etc). Also using this logic, we should avoid any healthcare in Nov/Dec because they’d process in January and it would apply to our newly reset deductible.
Can anyone comment on this? Can I remove the baby from our health insurance and re-run the claims (creating a new processing event) and revert back to our old deductible? We’d just pay for pediatrician visits for the last few months out of pocket, which would be cheaper.
Edit: We are in TX
submitted by /u/Branr
[link] [comments]Hi all, firstly I am thankful this forum exists, as I am extremely frustrated with UHC and have no idea what the truth is or how/if we can fight this. I even called a few lawyers (just seeking a 1hr consult) and can’t find anyone who works insurance legality. My wife and I had our first child 9/23 and were in the hospital 9/23-9/25. Everything goes through my employer’s health plan and that is the only insurance we have. It is a HDHP through UHC. Prior to our child’s birth we had met our deductible and were about $500 away from our OOP max. I read that services get billed to the mother until +3 days after the baby is born. Therefore we were expecting $500 OOP for the whole hospital visit. We knew that after 9/26, we’d be on the hook for the higher family plan deductible and OOP for anything else for the year. The baby was added to the plan (making it a “family plan”) 10/22, within the 30 days required by insurance. However I noticed on UHC’s site they’re not paying for some of the services rendered while we were in the hospital. I called them and they said any claim PROCESSED after 10/22 (when baby was added) applies to the new higher deductible and OOP max. Naturally, most of the claims were processed 10/25, one day after adding the baby (coincidence?) This seems like a conflict of interest to me, as UHC would have incentive to delay processing claims until after the deductible/OOP have been raised. It seems to me it should go by date of service, which is how all other insurance works to my knowledge (“date of loss” for home insurance, etc). Also using this logic, we should avoid any healthcare in Nov/Dec because they’d process in January and it would apply to our newly reset deductible. Can anyone comment on this? Can I remove the baby from our health insurance and re-run the claims (creating a new processing event) and revert back to our old deductible? We’d just pay for pediatrician visits for the last few months out of pocket, which would be cheaper. Edit: We are in TX submitted by /u/Branr [link] [comments]Read Morer/HealthInsurance