Five claims actually, all for one month in December. This is with a therapist I’ve been seeing for two years. Suddenly they’ve started sending her requests for more information, both for this period and others, all of which she has provided. They have accepted what she sent them for everything except December, 2020. I’ve talked to a half dozen UHC employees and have the information to file an appeal, but almost no idea what went wrong to begin with.
I have the list of documents required by the provider. The last person I spoke with at PNI said I must have been missing something on that list. The only info from the reviewer was that the “treatment plan was insufficient.” I asked if this meant there was something wrong with the plan itself or if something else on the list was missing. They could not provide any more information.
What are my chances of winning the appeal? I’m worried this may impact my coverage for the last few months as well, or upcoming – between the provider and myself we have spent hours on the phone with them with no answer. How do I get someone at UHC who knows anything or has any say? I really feel like I’m dealing with a machine at this point, my provider is worried they will just keep auditing everything and denying it, which has me worried, too. We have no idea what is wrong…
submitted by /u/SoundOfOneHand
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Five claims actually, all for one month in December. This is with a therapist I’ve been seeing for two years. Suddenly they’ve started sending her requests for more information, both for this period and others, all of which she has provided. They have accepted what she sent them for everything except December, 2020. I’ve talked to a half dozen UHC employees and have the information to file an appeal, but almost no idea what went wrong to begin with. I have the list of documents required by the provider. The last person I spoke with at PNI said I must have been missing something on that list. The only info from the reviewer was that the “treatment plan was insufficient.” I asked if this meant there was something wrong with the plan itself or if something else on the list was missing. They could not provide any more information. What are my chances of winning the appeal? I’m worried this may impact my coverage for the last few months as well, or upcoming – between the provider and myself we have spent hours on the phone with them with no answer. How do I get someone at UHC who knows anything or has any say? I really feel like I’m dealing with a machine at this point, my provider is worried they will just keep auditing everything and denying it, which has me worried, too. We have no idea what is wrong…
submitted by /u/SoundOfOneHand [link] [comments]Read Morer/HealthInsurance