Sunday, June 17, 2012

Avoid Working w/ United HealthCare, Medicare Advantage Plan, unless you are an IN-NETWORK PROVIDER: Refusing to pay When Medicare Clients Transfer On their Own

Well, I've got nothing better to do than to organize a bunch of paperwork to send to United HealthCare Appeals Department which entails printing out all of the patients' outpatient psychotherapy notes, creating a face page, sending a copy of it to the NC Insurance Commissioner as the client did not understand that a Medicare Advantage company can be an oxymoronic term. 

Almost one-half year's worth of weekly billing had been rejected x2 (it takes time to wind thru their system while I continue to honor my relationship w/ the client and see her) on the basis of:

                          Error Code: 0979: Member Self Directed Out of Network

So, for United Healthcare, if the Medicare provider is not 'in network' to that company, if the client picks that company as their Medicare Provider, you will not be paid. 

The woman on the line at United HealthCare, as she tried to talk the client out of switching back to Medicare insisted, "You could have seen oe of the providers we have" to which the client stated, "But I've been seeing Dr. Hammond since my husband died"-----indicating that the administration of United Healthcare has no idea of the nature of outpatient therapy. 

Hey: just switch over to that fella down the road.  Right.

She called them the other day to switch back to regular Medicare-----where I recommend ALL my clients to stay. 

I haven't had any recent trouble w/ Humana but two years ago they insisted I send all of my patients' session notes in order to pay me.  And by the way, that reminds me that the company that Humana had outsourced the outpatient mental health care only authorized until mid-year.

Whoopee!  More paperwork to create for Humana. 



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