Yes, we have had the same experience with UHC. Our practice is OUT OF
NETWORK but we still receive requests on most claims post submission to send
in full medical records. I believe a lot of UHC plans outsource their claim
review through OPTUM (3rd party company) that processes their claims. They
routinely request medical records and sometimes erroneously deny claims
stating “not medically necessary”, in which appeals are necessary to
overturn and obtain payment.
So, yes… this is absolutely an extra layer of stalling payment to
providers:(
Shana O’Brien
Senior Medical Billing Specialist,
Compliance Officer
Paul L. Valentine, O&P, LLC.
2139 Staples Mill RD.
Richmond, Virginia 23230
(804) 355-0283
(804) 355-2035
[email protected]
—–Original Message—–
From: Shawn Valentine [mailto:[email protected]]
Sent: Tuesday, December 22, 2020 1:03 PM
To: ‘Shana O’brien’
Subject: FW: [OANDP-L] United Healthcare Claims
—–Original Message—–
From: Orthotics and Prosthetics List
Michelle Jones
Sent: Tuesday, December 22, 2020 10:28 AM
To: [email protected]
Subject: [OANDP-L] United Healthcare Claims
Good morning, Listserv.
I’m curious to know if anybody else has had this experience with United
Healthcare. It seems that we are now getting requests for medical record
documentation on every single claim, even though we submitted the
documentation when we requested authorization. I understand that
authorization is not a guarantee of payment, but this seems to me to be an
attempt by United Healthcare to delay paying the claim.
Any thoughts or suggestions?
Michelle Jones, Insurance Specialist
Progressive Prosthetic & Orthopedic Services, Inc.
380 Cleveland Place
Virginia Beach, VA 23462
Phone: 757-456-5501
Fax: (757) 671-7525
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