United HealthCare Lab Billing

[Nick D]

UHC has stopped reimbursing drug testing (analyzers/confirms) claims filed through the labs with Place of Service 81 (independent lab). They are stating that they need to be billed from the location they were collected which, in this case, are substance abuse facilities. If filed from the facility, they consider it inclusive to the the per diem charge. They've created a scenario where labs are not reimbursable.

Does any one have any insight into a positive outcome??

*Some recoupment requests have begun*

[PMRNC]

If any of the UHC plans are ERISA you might be able to use it to appeal or stop recoupment. ERISA is federal and trumps carrier rules and provider contracts.

[Nick D]

If any of the UHC plans are ERISA you might be able to use it to appeal or stop recoupment. ERISA is federal and trumps carrier rules and provider contracts.

Thank you, I would utilize ERISA as a last resort. Right now I'm looking to see if anyone is still getting paid from UHC for labs.

[Michele]

Sorry but we've never billed for the drug testing with the 81 POS.  Only in office.  And the doctor stopped doing them because of issues with reimbursement.  Which hinders his ability to treat patients like he would like to.  It's so much better to say "pee in this cup" when you see signs that are alarming, rather than say "Please go to a lab and have this test done ASAP."