Author Topic: Out Of Network Surgery Claims  (Read 4796 times)


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Re: Out Of Network Surgery Claims
« Reply #15 on: January 26, 2016, 07:29:29 PM »
Howbeit, I also am fully aware of tactics used by UHC and Viant, whereas, they are not fully paying what the members' policy requires.

What tactics? it's basic simple U&C/R&C.
Linda Walker
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Re: Out Of Network Surgery Claims
« Reply #16 on: January 26, 2016, 08:19:51 PM »
Hello Linda,

I wish that it was as simple as U&C/R&C.

However, due to the fact that this is a public forum, I cannot disclose what I have uncovered or I open myself up for a lawsuit.  BTW, I have had two frivolous lawsuits filed against me because of the line of business that I'm in, therefore, I am careful in what I disclose.

Having said that, even what is considered U&C/R&C by a payer can be questioned.  Also, there is the question of what percentage of U&C/R&C a policy agrees to pay on out-of-network claims, which, may not always be the same percentage of what payers actually pay.

I have also uncovered another underpayment tactic used when a payer pays at U&C/R&C.  I have uncovered many underpayment tactics used by payers which is not always easily identifiable.