Does everyone billing for UHC have a capped payable amount of $45/day? This has been the case for us which we understood to be the doctor's contract but now we are seeing that some claims break the visit into separate sections and they pay separately for each section.
ie if we had a new patient and billed out
99203-25
72040
72100
98941
98943
G0283
97010
When we received the EOB, they separated it into several sections and this is how they paid:
99203-25
98943
G0283
97010
Allowed Amount $45
72040
98941
Allowed Amount $45
72100
Allowed Amount $45
We have called UHC multiple times about this and they keep saying it is processed correctly. We were also told that the doctor's daily capped rate is different and separate to what is allowed and therefore paid or owing by the patient. In the case above, the patient still has a deductible so we would be charging them $135. Is this right? I'm not understanding how a capped $45/day rate can be $135. The odd thing is this happens for some of the claims over different patients. For most of them, the $45/day allowed amount applies.
Does anyone know about this that can help advise??
