ER Physician Service appeals to UHC on my behalf (hospital, doctor, federal)
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I went to the ER in early January of this year. UHC paid 2 providers:
1) the hospital - Amount billed was $1807, UHC paid $960, I paid $125
2) the ER Physician Service - Amount billed $1006, UHC paid $653, I paid 0
I got an acknowledgement letter on Friday from United Health Care saying the the ER Physician Service sent a letter on my behalf to the UHC Central Escalation Unit. I called UHC today to find out what this is all about and the CSR wasn't very helpful or I didn't understand her. She said that the ER Service is requesting payment in full so they appealed? Is this normal procedure? The CSR told me to not worry about this since I don't own anything.
That doesn't make me feel comfortable. I had a dentist send something to collections (20 years ago ) that I didn't know about until I went to buy a house 15 years ago. Will I ultimately find something like this from this situation, or is this just not something I need to concern myself with?
Sometimes the ER physicians aren't in the network, even though they are working at a hospital that is in. There has been a lot of controversy about this.
Probably not but I wonder if they’re actually in network.
When the payor says the filed an appeal on YOUR behalf...it sends up a red flag.
That sounds to me like they’re “doing you a favor” before hitting you with the bill.
If they are in network, I think you should be OK.
Definitely keep an eye on the process.
You are not required to respond to this letter. This is an acknowledgement that we received a letter sent in your behalf in the UnitedHealthcare Central Escalation Unit. If your request qualifies for an appeal, grievance or complaint, we will complete our review and send you a letter about the decision within the required timeframe consistent with pertinent state or federal regulatory requirements. All other requests will be handled as normal course of business.
We want to make decisions about our customer's requests on complete information. If, however, you, or a representative has any information that might help us in our review of this request, please fax it to 999-999-9999 or send the information as soon as possible to: 2 addresses provided, 1 for providers, 1 for members.
I looked this provider up on my account on the UnitedHealthcare website. They show in network for the hospital address in Miami where I went. They have a 2nd location, an address in Ft. Lauderdale that shows both in-network and out-of-network on the same webpage. LOL
This is the first I've heard that the ER Service is appealing anything.
Humm, based on the letter, it is a bit confusing since you never asked for anything. The next step is to contact provider that initiated the action and ask them whats up. They are the ones who initiated this so only they can explain to you the why and what.
Used to work for an ER Physicians service who staffed many hospitals in the Chicago area. They are billing on THEIR behalf. They would like your insurance company to pay more. Hope you realize that every time you step into an ER staffed by an outside physician service, that the actual ER doc gets reimbursed based on the contract and may times he/she is paid a portion of what they bill for you. So, they order all those tests you may not need because it is more lucrative for them. Unless you are severely sick or injured...better to see the primary physician than go to an ER unless you have lots of $$$.
Humm, based on the letter, it is a bit confusing since you never asked for anything. The next step is to contact provider that initiated the action and ask them whats up. They are the ones who initiated this so only they can explain to you the why and what.
I printed everything out and will just keep the paperwork until/if this comes back to me.
Quote:
Originally Posted by LynnKrause1
Used to work for an ER Physicians service who staffed many hospitals in the Chicago area. They are billing on THEIR behalf. They would like your insurance company to pay more. Hope you realize that every time you step into an ER staffed by an outside physician service, that the actual ER doc gets reimbursed based on the contract and may times he/she is paid a portion of what they bill for you. So, they order all those tests you may not need because it is more lucrative for them. Unless you are severely sick or injured...better to see the primary physician than go to an ER unless you have lots of $$$.
I had been to urgent care and was not getting better so they said to go to the ER. So the ER service got $653 from UHC for the approximately 10 minutes the doctor spent with me. How much of that does the actual doctor see?
And how do I know that the ER is staffed by an outside service? Do I have to find this out before going or having an accident? Can I tell the ambulance driver to go to a hospital staffed by ER doctors that are onsite vs. an outside service?
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) that I didn't know about until I went to buy a house 15 years ago. Will I ultimately find something like this from this situation, or is this just not something I need to concern myself with? 
LOL 
