Mail fraud? Is it any different from any other company sending false billing when they have been informed many times otherwise?

I've heard, from someone that works in health care, that the companies routinely deny a percentage of claims because most people won't fight it, especially if it's a small amount. Pretty crappy customer service, but I'm sure it saves them a lot of money

Why are you blaming united health care and not the doctors office. The doctors office screwed up not united. United health care probably paid them already and the doctors office still has it in their system that you owe them the 90 dollars.

I know this is a bash big business site but i do feel its the doctors office billing you when they shouldnt be. They seem like they are palcing the blame on your insurance company when its not the insurance companies fault.

Stephen_J_Hemsley@uhc.com
George_L_Mikan@uhc.com
David_S_Wichmann@uhc.com
William_A_Munsell@uhc.com
Thomas_L_Strickland@uhc.com
Lori_K_Sweere@uhc.com
Anthony_W_Welters@uhc.com
Eric_S_Rangen@uhc.com
Richard_T_Burke@uhc.com
Thomas_H_Kean@uhc.com
Stephen_Hemsley@uhc.com
George_Mikan@uhc.com
David_Wichmann@uhc.com
William_Munsell@uhc.com
Thomas_Strickland@uhc.com
Lori_Sweere@uhc.com
Anthony_Welters@uhc.com
Eric_Rangen@uhc.com
Richard_Burke@uhc.com
Thomas_Kean@uhc.com
SHemsley@uhc.com
GMikan@uhc.com
DWichmann@uhc.com
WMunsell@uhc.com
TStrickland@uhc.com
LSweere@uhc.com
AWelters@uhc.com
ERangen@uhc.com
RBurke@uhc.com
TKean@uhc.com

Good luck.

@majortom1981:

I agree - the dr's office is at least as likely to be the culprit here.

@majortom1981: I think if UHC had paid the doctor they would say so when she calls to see why they haven't. Instead they say send more paperwork, so this probably is on UHC's side.

You are not alone in your battle with UHC- my company uses UHC for their health plan and it's so ugly that a lot of us have opted to just not have coverage at all. They do indeed deny a percentage of claims to try to reduce costs, all the while you're paying higher than industry average for premiums.

UHC is a joke, it's much easier to go in and say you aren't insured, and then pay the reduced rate (we call it the alien rate) which comes out to be about 1/3 of the cost of the total bill everytime.

Don't tell UHC, but my company is planning on dropping them very soon. This should be a major blow to them- because we are the largest employer they provide health insurance for.

@majortom1981: UHC is admitting they are not paying the bill. Of course the problem is with UHC!

Shit. I have UHC through my workplace and my copay here in Arkansas is $20. I haven't had any problem with billing - yet.

"Human capital". how depressing.

I have been through this so many times myself I can do it in my sleep - You need to get a copy of your EOB that shows you owe $0 (you said they drafted one) - Then, fax that to your doctor's office with a note reminding them that is ILLEGAL for them to counter-bill you for services for which your EOB says you owe $0. That dispute is between your doctor's office and your insurance - they need to leave you out.

Good luck!
PS - good work not giving in and paying the $90 - just another nightmare to get that back!

I've had to deal with UHC many times on stuff like this. Usually it's the doctors office that is the problem. They have to submit the procedure as a standard code that all insurance companies/doctors offices use. If the dr. office uses the wrong code the UHC computer spits it out and doesn't pay. I call UHC and they tell me to contact the doctors office and have them re-submit the bill with the correct code. If the book keeper is an idiot like some I've dealt with they will just submit the same numbers again knowing that the numbers are wrong. Once it got so bad that the lady at UHC called the doctors office for me and called back later and told me that the book keeper is retarded (their words, not mine) and that they are at a lose as to what to do. I called the doctors office back a few more times and eventually they just sent me to collections. I've never gone back to that doctor...

@lookatmissohio: UHC, I thought that stood for United Human Cattle?

She need to get UHC to tell her it is paid or not paid and fax her printed proof of the status of this. If they say they paid the doctor already demand they fax her some hard copy proof. Something like an account ledger or an account record of the check or funds sent to the doctor.

Either UHC is lying and they won't be able to pony up proof of payment or the doctors office is lying and with proof of payment you can press them to stop trying to double dip between the insured and insurance company.

If UHC admits they never paid it or can't provide proof they paid the doctor then the issue is with them. Sic the state insurance board on them like hungry pit bulls.

What's interesting here is with my new UHC coverage this year, preventative care is the ONLY thing they cover until I pay my deductible. Yet here they are refusing to pay for preventative care for someone else. You just have to love the creative policies health insurers come up with!

@hillsrovey: How many people would pay the $90 because they are terminally busy or have no idea how to fight these things and think they have no choice. I would guess easily 30% would pay it.

Getting some free money out of 30% of your patients or getting 30% of your insureds to pay their own bills in full is some pretty significant money.

I had to go to the ER a couple of months ago because I had an allergic reaction and my throat swelled up and I was having trouble breathing. After a shot of benadryl and some antihistamines I gave the ER my insurance info and paid the $20 copay and 3 weeks later I get a bill for $900 from the Hospital saying that they never got the money. Luckily, I was registered with Aetna's client website that lets you look at who has filed claims and if they've been paid, and sure enough the hospital had filed the claim and Aetna had paid them. (I had a PDF of the form with signatures and everything)
This isn't the first time I have been billed for services that insurance has already paid for, a year earlier my optometrist did the exact same thing. Sometimes it really is the Doctor's fault.

I had the worst issue, I found out if you call your AG the calls and bills would stop. The AG is my state TX loves going after insurance companies.

There's also the very real possibility that the doc's office aren't submitting the doc's NPI and may be submitting UPIN. Especially if it's a nurse practicioner that may not have an NPI.

I received a bill from sonora quest laboratories yesterday saying UHC had revisited my account and decided that $5.06 was not covered. Nice that UHC can take back money already paid almost a year later.

I used to work as a Customer Service Rep for United Healthcare, so here are some questions.

When was your last routine check up? If it was within 12 calender months (To the day exactly, you can't go a day early on some policies.) it will not be covered. Some have every six months, the same policy applies. You have to make sure, that your routine visits do not fall within your limit.

Secondly, find out the Tax ID number from the doctor. You can't ask about the Tax ID number over the phone, but if you provide them with one, they can say "Yea" or "Nay" if it matches.

Find out if the doctor that they used is in UHC as a provider, they may be billed under a group Tax ID number, and individually not be covered. Find out if they have a group/practice Tax ID number or contract with UHC.

Ask the CSR to read you the history notes, make sure that UHC has recieved BOTH claims, and ask them for the Dates the claims were processed.

Once you have this, ask about the secondary claim (The one that came under the different doctors name. You can search by doctor name, date, and Tax ID number for claims.)

Also, ask them to go into the Claim, and look up the Denial Code, there is a code right in there that if the CSR is smart enough can reference and say. "This was denied because of..."

IF they tell you otherwise, they are lazy CSR's and you should speak to their supervisor. Tell them you know a person who worked at the Chico, CA, UHC, and that you know what they can, and can't do. Tell them to go into the back end if they have to.

When I was working claims, I worked in the DOS screen and old system more, because you can navigate and find information faster than the ugly GUI they had everyone using.

Seriously, ask these questions and you should have an answer. Chances are, the claims department tried to push through the original bill rather than the updated one.

I say bring on Universal Health Care for everybody!! I'm paying $700.00 a MONTH just to cover my wife and daughter. I want what France/Canada/etc has!!! FREE health care for all. I rather pay more in taxes than what I am paying now each month!! Watch Sicko, you'll see.

Sorry, I hate to post twice, but if anyone else has any questions I might be able to dreg up enough memory to help with UHC. I did claims for Blueshield, so I don't know the CSR stuff. Sorry.

(Edit on above comment : Make sure they're using the right code, there is a five digit code they need to submit with their claim. If they submit the wrong code, it could be seen as something other than routine check up. MAKE SURE THAT IS RIGHT, a CSR or Claims Adjuster cannot, CANNOT change this, no matter what, it is against the law and the CSR could be fired for even saying they can do anything. If this is the reason for it, have them resubmit ANOTHER claim with an adjusted HCFA-1500 code. The HCFA-1500 is the claim form that almost all doctors use, and is used in the professional sector. UB-92's are the hospital forms...)

My wife and I are having similar problems with our insurance company and doctor.

My insurace does not cover our geographic area, but because my contract works in the area and that is where I am employed, they have contracted with the regional hospitals and doctors affiliated with the hospitals.

But when our family doctor bills us, they bill us based on the insurance company and not the contract. It is a pain in the butt, but the insurance company handles it.

We like our doctor, it is just the billing office. After several calls to them, they straighten it out for that bill, but it happens later. We have told them several times to note the special circumstances, but it seems to be futile.

I wondered why they were buying all the forklifts and cattle prods@bohemian:

Your doctor's billing office is not fighting this battle enough for you. They should be. The way this sounds, at the first denial they are just billing you and not getting on the phone with UHC to duke this out with them. They have more knowledge about insurance billing and are better equipped to be fighting this denial. And I say this as someone who works with health insurance and a large hospital and has either fought these battles for a patient, or has seen others in her department do so.

I agree about asking a CSR for a denial code for the claim each time you call them. This way you keep a more specific record of the reasons they are giving you.

@DrGirlfriend : I wish it worked that way, most of the time in all honesty the Doctors Offices let the patients out to dry. I had to fight for most of my members with my doctors office to get them to bill correctly, keep dates straight, hell I even had to bust a Dr's chops for trying to charge a member OVER the comp'd amount.

(Basically, if a doctor charges you 200 for a visit, and UHC only pays 120, thats 80 dollar difference is a write-off. I've had doctors try to bill patients for it, not understanding this. Very frustrating.)

If it's a small practice, the doctors and secretaries have no idea what they're doing in all honestly. They pick up one of these professional programs, or professional packets that have all the codes in there and they just scroll through selections .... very poorly.

I agree, large hospitals are WELL equipped, and when dealing with UB's I had very few problems (Some line item deductions and silly stuff, but honestly the hospital bills I loved seeing because they were professional.)

I have UHC, get used to it. They manage to reject 60% of my family's claims. After calling and having them resubmitted most (2 or 3 last year) get approved. The rest take an additional call. My wife's claims get rejected the most. They even manage reject all her claims on one doctor that we both see, while my claims go through every time. Same policy, subscriber ID, etc.

Something similar over blood work done. I pay 80% of in network fees but they billed me for 100% of out of network because on the paperwork submitted I was told they had the incorrect gender code and even though I am female and have been female with this insurance company (not the one I'm with now) for years, they denied the charges because they claimed as a male I didn't qualify for the bloodwork ordered. Had to have dr resubmit but it took me a while to figure out why they kept denying the claim (insurance company wouldn't say--at first just saying they deemed the tests unnecessary). My bill was for $350 I believe--went to collections, out of collections, threatened to go back into collections, before finally it was settled and I owed under $35 (after in network discounts). Took about 9 months to get settled.

This was the same lab (quest) that did duplicate bloodwork on a previous visit--billed me twice, from the same blood sample taken the same day, and had different results on the same test -- over a 10 point difference. Quest labs argued the dr. ordered the test twice (as if) but even if he had, why is the result so different on the same sample of blood? Eventually they agreed to charge me for only one test once I got the dr's office involved.

Whoops I mean in earlier post, I pay 20%--80% discount.

@gingerCE : Yeah, you'd be amazed how awful Quest is. I've had run ins like that.

A Good CSR will notice things, will look over the claim. You always look for Gender Codes on gender specific procedures. This is why knowing the ICD-9 Codes (The codes on the HCFA-1500's) is so important...

There are books in Barnes and Noble that a craft consumer can read, or maybe even a library where one can Xerox... If you are having trouble with your doctors office billing incorrect ICD-9 Codes, the best thing to do is find the one they use (I believe normal Dr's visit is something like 99123) and research to make sure that the code they are using IS the code that they need to use....

Agree with everyone about the Dr.'s office responsibility. Mine will go to bat for me with the insurance co. We've had a similar circumstance and they took care of it internally and told me after the fact. They wanted to get paid!

@Freedomboy: What's with the pottymouth?

@Antediluvian: It's edgy, didn't you get the memo?

I had a similar situation last year w/ Blue Cross. Slight difference -- the doctor billed me AND the "hospital" billed me: the doctor's "office space." Messed up beyond belief.

Finally, after getting totally fed up, I said to Blue Cross: This is not MY problem, this is YOUR problem. _I_ am not going to call the billing party FOR you. You know the "magic words" to get them to fix this problem; I do not. I don't know your lingo and I should not be expected to. Here is their phone number. Call them and get this done.

Summary: put the two parties together on the phone. Conference them in if they won't call for you. This should not be your fight -- it should be their fight. Make them do the work.

@Antediluvian: Most CSR's don't have the ability to call out from the center. There is an escalation unit that can, and will do this. But, they are a small group among many incompetent people.

You're dead on, if you can conference or threeway with your biller, your healthcare, and yourself... It will go much smoother every time. It's the best advice in these comments and I'm jealous I didn't say it :D

I had a lot of fun dealing with UHC when they RETROACTIVELY cancelled my wife's insurance when she switched providers....so getting them to REPROCESS all the claims is still haunting us...

@Dibbler: Exactly what I was thinking. Is it possible she's being billed because a Nurse Practitioner is down $90 in bill payments but the Doctor who they submitted the claim against is suspiciously showing a $90 credit?

We have horrible problems with health insurance, but to believe Sicko - that health care in Cuba is great for everyone - is tantamount to believing the moon is made of Cheddar.

I work in medical billing and see situations like this all the time. First of all, your physicians billing department is in the best position to help you. However, the fact that they are simply submitting statements to you without attempting to offer any help is unprofessional. I would not continue to see any doctor whose billing department abandoned you like this.

Secondly, this appears to be the fault of UHC, not your physicians office. If your doctor is a participating provider, he/she probably has a long history of billing clean claims to UHC. Your claim should be no different. If they are questioning the Tax ID of your provider, it sounds like they are processing it as out-of-network. Sometimes all it takes is a phone call (which in your case didn't work), and sometimes I have to appeal the claim with office notes so that it is bumped up to someone else in the appeals department. Regardless, your physician should not be shrugging their shoulders and forcing you to handle this. They have a contract with UHC and they need to ensure their claims are being processed according to their contract.

In reality, your physician's billing department should be your best weapon in having this claim processed correctly. Make them do it. Once this is over, find another physician to be your OB/GYN.

@dorkins: mmm... chedder

you do realize you're the only person on this thread who mentioned sicko? you also realize this post wasn't about cuba, but a zombie bill?

@hi: I think people are getting their panties in a tussle because of the picture on the post... But, you know, over-sensitivity is a national past time in the US.

@hi:

Some people can't see past their socio-political blinders.

I have found that a good solution for dealing with the insurance company when they are causing problems is this:

1. Attempt to work it out with them directly. Use the mail, not the phone, because you don't know for sure that the CSR took the right notes. Copy the doctor's office on the missive so that they know you are trying to work this out (this can sometimes help stall any collections actions).

2. If that fails, send another missive, but this time, also copy the HR department of your employer (assuming HR is the department responsible for employee benefits). Follow up a day later with a phone call to HR. If they start hammering on the insurer, the insurer is more likely to listen, because, unlike you, your employer has the option to go somewhere else.

I'm in the insurance business, it really does sound like this is a billing issue that you need to be out of, this should be between UHC and your doctor's billing dept.

This is the Alexis from the post. Thanks for all of your input, everyone. I will keep you posted, and hopefully this will be taken care of once and for all.

If you are covered under a group policy, definitely contact HR. Your employer most likely has an agent and the agent has access to UHC individuals who handle escalated issues. Ask your HR department to call the agent or ask for the number directly.

Besides, as kc2idf said, your employer can choose to change insurance carriers if they are not satisfied with the service they are receiving.

@evilinkblot: Easy to say, but I've seen patients getting bills sent to collections as a result of this. The OP needs to be proactive and make sure that doesn't happen by contacting their agenet/broker.

Wow! So many hurdles just for a freakin' checkup!
God bless American Healthcare!