I had an outpatient procedure done at the beginning of January that was pre-authorized by United Healthcare . I just received a claim today and it said that I am responsible for the procedure because it was at an out out network provider therefore my claim was partially denied. The bill itself was over $20,000 but due to my max out of pocket for out of network providers, I have to pay $7500.
I called and spoke to a representative and explained that although my surgeon was in network the system was showing that the hospital was out of network. Here’s where things get weird. She looked up the clinic by name and it was in network. The address of the claim was in network. She reviewed the tax ID and that tax id was linked to an in-network provider/hospital. She also checked to see if my surgeon had the in-network hospital on his profile and he did. She wasn’t sure why it was denied and sent it back to be reviewed.
So my question is, is there any other reason why the claim could be declined?
submitted by /u/DamRoki
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I had an outpatient procedure done at the beginning of January that was pre-authorized by United Healthcare . I just received a claim today and it said that I am responsible for the procedure because it was at an out out network provider therefore my claim was partially denied. The bill itself was over $20,000 but due to my max out of pocket for out of network providers, I have to pay $7500. I called and spoke to a representative and explained that although my surgeon was in network the system was showing that the hospital was out of network. Here’s where things get weird. She looked up the clinic by name and it was in network. The address of the claim was in network. She reviewed the tax ID and that tax id was linked to an in-network provider/hospital. She also checked to see if my surgeon had the in-network hospital on his profile and he did. She wasn’t sure why it was denied and sent it back to be reviewed. So my question is, is there any other reason why the claim could be declined?
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