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United Healthcare / eob - explanation of benifits

1 CA, United States Review updated:

Several Explanation of Benifits indicate that the submitted claim was not paid because the physician was out of network. I've been with this Primary Care Physician for several years. I checked their directory of In-Network providers and he does appear on the list. To submitt an appeal you have to print and complete a form, then send it via postal mail. In this day and age of modern information systems you would think that United Healthcare could provide this service online. I would guess that they are trying to delay as long as possible having to address the complaints.

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  • Cg
      30th of Apr, 2009
    -1 Votes

    The doctors, clinics, etc should NOT be sending their patients to places for further treatment, that ARE NOT in the network, They are suppose to be knowledgable of whom THEY work with, so don't blame the patient. I see that as your screw up that you pass on to your patients!

  • Ma
      31st of May, 2009
    0 Votes

    So far this year UHC has paid five claims of ours as out of network for providers that are clearly in network. The reason they give is the provider billed for a code he is not authorized, an extended office visit instead of a regular office visit. This shift the entire claim to my out of pocket. If the provider made a mistake why should it be my responsibility? UHC is really disreputable.

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