Question:
United Health Care Post Op going back on their coverage
Even after United Health Care pre approved us and our pre surgery appointment with Bariatric Treament Center had us sign a form that said we would be responsible for $1000 each, we got a letter from United Health Care saying that they would only pay 70% of the bill because our doctor was "out of network" In all of our conversations with United Health Care, they never mentioned this before surgery! My first question is can they do that? My second question is has this happened to anyone else? Thanks — anadrama (posted on August 1, 2003)
August 1, 2003
Anna,
I haven't heard anything negative from United Healthcare regarding my soon
to be surgery(fingers are tightly crossed)however I do know with everything
else I've had done in the past with all my doctors, if they're not in the
network you do have to pay extra. Fortunately my surgeon and hospital are
in network. Can you research and find one who is and save you some bucks?
Nancy
— nancysho
August 1, 2003
I know that is usually how it works with Ins. Co's out of network they pay
less, it is unfortunate that you already had your surgery before you found
out. It would be nice if they told you all of those things but unfortunatly
I think it is pretty much left up to us to check into all those things.
— Saxbyd
August 1, 2003
I'm sorry that they did that! My situation is not that similar to yours,
however, I have found that UHC customer service is very inconsistent. After
12 conversations with 12 different people, I finally figured out to talk to
a superviser. Then I got the right answer, even if it wasn't the one I
wanted. Good luck. Be persistent.
— SweetDragonfly
August 2, 2003
Maybe the $1000 is your 30%. They knew it up front so that's what you
paid. Have they billed you yet? If they have, ask why when you paid $1000
already. Chris
— zoedogcbr
August 2, 2003
Please don't shoot the messenger...I think on this one it is your fault for
making an assumption that "approved" meant they were in-network.
I also have United Healthcare PPO and one of the joys of that plan is the
flexibility to go to out of network doctors. THAT is the reason many pay
extra for the PPO vs. EPO/HMO. I do not believe they "went back on
their coverage" but simply are avising you on the portion would you
have to pay and it sounds like UHC is doing this as soon as BTC has let
them know the total amount. You did not state whether BTC insists on that
being up front or not (that will be their decision) I too had to pay the
part I owed (and in advance) on my surgery for an in-plan surgery (though
it was much-less). In my opinion, it should have been BTC's
responsibility to make your payment situation clear - the doctors' offices
are the ones who knows what each company pays - and if they didnt' tell
you, they were probably more concerned with you choosing someone in-plan
(i.e. they would lose your money). There are a lot of great in-plan
surgeons with UHC and it sounds like they knew you would find out. You
need to look at the bottom of your last statement from UHC and see what the
total of your "deductible+out of pocket max" for OUT OF NETWORK.
This will tell you the cost of your surgery. These are calculated
separately for in and out of network. If you carry more than just yourself
on the plan, the amount can be high. If the $$ is really an issue, you can
still switch to an in-plan surgeon and just use the out-of-plan pre-op
tests. If you were approved once, you would be again. For in-plan, UHC
PPO covers 100% of diagnostics. I'm sorry th is happened to you (the
confusion) but it does not sound as though UHC did anything wrong, since
that particular plan is designed so you can go out of plan. If you need
more specifics, write back and I'll be happy to share.
— Donya P.
Click Here to Return