Hello,
My insurer is UHC. We used an out-of-network midwife when we had a baby last month. This is #5 and we have always used a midwife and they’ve all been out of network. We pay up front, so we file for reimbursement. We have filed claims or had a billing company assist us with our claim, to varying levels of success.
This time I made sure to get CPT and ICD codes for pre-auth to ensure everything would be at least squared away as far as the approval. It was–in fact, the midwife clinic was already in the system so that was a good sign to me. I got a letter saying: “These services will be covered at the network level because currently there isn’t a doctor, health care professional, or facility in your area to provide these services.”
I filed the claim online a couple weeks ago and it just came through. Out of $3,200 (global CPT code), they’re paying about $700, which is great. However, the EOB says “ND: THIS OUT-OF-NETWORK SERVICE WAS PROCESSED BASED ON MEDICARE ALLOWED AMOUNTS OR OTHER SOURCES IF NO MEDICARE AMOUNT IS AVAILABLE. THESE AMOUNTS ARE USED EVEN IF THE PATIENT DOESN’T HAVE MEDICARE.”
I’m thankful they paid so much in the first place, but the way they wrote the EOB, it makes me wonder if they did not process it the way they said in the approval letter.
But, what do I know? Just curious if anyone has any insight. Thank you!
submitted by /u/Tenmaru45
[link] [comments]Hello, My insurer is UHC. We used an out-of-network midwife when we had a baby last month. This is #5 and we have always used a midwife and they’ve all been out of network. We pay up front, so we file for reimbursement. We have filed claims or had a billing company assist us with our claim, to varying levels of success. This time I made sure to get CPT and ICD codes for pre-auth to ensure everything would be at least squared away as far as the approval. It was–in fact, the midwife clinic was already in the system so that was a good sign to me. I got a letter saying: “These services will be covered at the network level because currently there isn’t a doctor, health care professional, or facility in your area to provide these services.” I filed the claim online a couple weeks ago and it just came through. Out of $3,200 (global CPT code), they’re paying about $700, which is great. However, the EOB says “ND: THIS OUT-OF-NETWORK SERVICE WAS PROCESSED BASED ON MEDICARE ALLOWED AMOUNTS OR OTHER SOURCES IF NO MEDICARE AMOUNT IS AVAILABLE. THESE AMOUNTS ARE USED EVEN IF THE PATIENT DOESN’T HAVE MEDICARE.” I’m thankful they paid so much in the first place, but the way they wrote the EOB, it makes me wonder if they did not process it the way they said in the approval letter. But, what do I know? Just curious if anyone has any insight. Thank you! submitted by /u/Tenmaru45 [link] [comments]Read Morer/HealthInsurance