Hi Valerie,
I really sympathize with you. I can't believe the number of people just like you that contact us. It is amazing to me that these places do this. You have insurance that will pay but they will not do anything to help you get reimbursed.
Anyway, it is a UB04, not a UB92. The UB04's replaced the UB92's on May 23, 2007. When you spoke with UBH did you explain to them that the facility refuses to complete the UB04 for you? It doesn't seem fair that they can require it from you. There is no way an individual can complete a UB04 form. I would start with UHB and ask for a supervisor. Tell them that the provider will give you a statement of charges, but they will not and are not capable of completing a UB04 form.
If you don't get anywhere doing that, let us know. But that is where you should start.
Good luck!
Michele