Medicare Advantage Question

I am new to Medicare Advantage. I have two claims that have been submitted to United Healthcare from two different Doctor’s offices where there are coding problems–either incomplete or missing codes. The doctors have not been paid. UHC has requested the appropriate information from the providers in order to complete the claims and send payment based on my plan. The information UHC needs has not been provided by either office. One of the claims goes back to November 2023. I am being charged for the full bill from one of the offices. UHC has been working with me to try to get in touch with the medical providers and ask that they to re-file. NO ONE is answering the phone, day after day. I’m calling and UHC is calling. I’m on the hook for $3000 for one bill and $1500 from another. Does anyone have advice?

Can you email or send a registered letter tyo them?

Does the office do its own billing or do they use a third party? If the latter, go straight to them.

I have had some success (usually when the insurer is stonewalling) by calling 1-800-MEDICARE. I am a UHC agent and a client is having a similar problem except he hasn’t been billed the $30,000. Network providers are required to bill promptly and correctly but things do go wrong sometimes.

This sounds like more of an issue with the Doctor’s offices. If possible, maybe you could go to the office and speak with a manager, or someone involved with billing for that office. I would not pay the bill from the doctor’s offices. Once insurance does pay, getting a refund back for the doctor’s offices could be more trouble than what you are having now.

I watch health care billing closely. Many years ago, when we had to submit claims via paper to insurance companies, almost every bill would be wrong. Getting them corrected involved a lot of effort. Things do seem to be better now, but the errors still happen.

One more thought…

This sound like a good situation for placing a call into Clarks Consumer Action Center.