Author Topic: United Healthcare Medicare Solutions  (Read 169 times)

Moogus11

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United Healthcare Medicare Solutions
« on: May 14, 2020, 02:01:08 PM »
Is anyone having issues with United Healthcare Medicare Complete? They require that I submit documentation for every surgery and hospital consult our doctors perform. This process delays payment 30-60 days past when I receive payment from other insurance companies.

Pacemakers are a whole other problem. UHC Medicare Complete requires authorization for every pacemaker placement, even if the patient was already in the hospital, and now every generator change. Then they deny all pacemaker claims for lack of authorization, even though the surgery was authorized and I can prove it. This leads to a series of appeals and denials that can last months. I just got paid for a surgery from December, after a tremendous amount of work and frustration.  I have another claim from December that I'm still fighting for.

Many would not put so much effort into claims that pay such a small amount, but it's the principal.  Why should my surgeons perform pacemakers for free, while UHC Medicare Complete gets out of paying what they owe?

kristin

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Re: United Healthcare Medicare Solutions
« Reply #1 on: May 14, 2020, 09:17:16 PM »
The first thing I would do is contact a provider representative, if you have one, and go over all of this with them, and find out why this is happening. Barring that, I would be sure to send in OP reports and IP notes with every claim for those types of services, so that they get the claim and the documentation all at once. That might prevent the lag between them receiving claims and requesting notes, and they can process the claims more quickly.

As for the pacemaker/generator issue, with the auths...do they want the authorization number on the claim? Do they want something in Box 19 on the claim? There is a disconnect here that you need to get to the bottom of. And yes, it is the principle of the matter, I agree. I am not sure if the provider is contracted with UHC or not, but everything needs to be argued/appealed, even if it means highlighting the treatment note to explicitly show where the service was rendered.