OON with UHC and Appeal Process

[Lapat79]

I have been handed some denied claims that were denied as late as December 2018 to file appeals on. The previous billing company never appealed them. Is this even possible? I can’t seem to think of any good reason that they would extend the 60 day filing period. I do not believe telling them that the previous billers did not do their job will get it done.

[PMRNC]

If any of these claims are with ERISA Group health plans you could get the patient's SPD and appeal using ERISA, in many cases the timely filing limit is much longer and since ERISA is Federal law it trumps both the state and carriers rules.

[Michele]

It may be worth a try.  If there is a provider rep for any of the plans I would contact them.  We have had provider reps who did a one time exception in situations like this.

[HSUMNER18]

I have found UHC to be very lenient in their appeal process. I've had other insurances follow their rules by the book but UHC  let me through with no problem after we switched EHRs and had some claims fall through the cracks

[Michele]

Wow!  I'm in shock.  I find UHC to be one of the most difficult, especially for timely filing.  We sometimes have rock solid timely filing proof and our appeal STILL gets rejected!

[azeemgillani]

You must contact with UHC Network Representative assign to your area. You can discuss any issue whether related to late filing or any other and they he/she will definitely help you out as i do have a experience and i got processed lots of late filing and other appeals through them.

Best of luck!!

Regards,
Azeem

[PMRNC]

Why beg or barter when you are entitled to reimbursement? Again if any of these are ERISA the 60 day limit does not apply as most group health plans have 180 days and some even 12 months.