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UNITED HEALTHCARE UNDERPAYMENT
PMRNC:
Extended Non-Network Reimbursement Program -https://broker.uhc.com/articleView-16399
Looks like it's most likely patient responsibility. There is a link however for "MEMBERS" if they want to arbitrate or dispute balance due bills.
In doing a bit more research it looks like UHC launched this a few years ago in FL, AZ, TX and Missouri.. it also looks like it's based on higher reimbursement than U&C BUT lower than if providers were participating. This means your claims were processed as OUT of network. Means you have every right to bill patient for any balance due.
kita...:
Do payers not have to adhere to the Greatest of Three rule? Even if it is out of network, it can still be paid at an in network rate, or whichever is higher.
PMRNC:
--- Quote ---Do payers not have to adhere to the Greatest of Three rule? Even if it is out of network, it can still be paid at an in network rate, or whichever is higher.
--- End quote ---
No, not at all. Non contract they pay based on U&C. They use the 80th percentile in determining U&C The insurance plan then calculates the amount payable on the claim on the basis of this U&C fee or what 80 percent of physicians would charge for that service in that geographic reason, whichever is less.
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