You should call back and talk to another representative because the one
you talked to is completely incorrect. The health care provider can
resubmit up to 6 months after the time of service. I've dealt with
United Healthcare many times and they have always been very helpful with
any problems I've had.

They have even resubmit the paperwork for the health care provider when
I've provided the needed information. It doesn't get much nicer than
that.

So far only one claim has ever failed to be paid and that was because
the health provider used the wrong insurance number to file the claim.
And because the health provider never notified us of the problem it went
past 6 months and they had to write it off. I promise I paid dearly for
the health care provider's mistake.

As a last resort you can always file an appeal for any claims not paid.
But I have never needed to go that far because United Healthcare has
always been willing to fix the problem if they could.

Ninety percent of the problems I find are the health care providers file
the claim without the referral number. The health care provider need
only resubmit with the referral number.


On Tue, 2007-11-06 at 10:26 -0500, W. Leroy Fanning wrote:
> To be sure I am not one who rants very often but the manner that
> UnitedHealthcare chooses to treat its valued customers needs to be
> discussed.
> 
> My wife, Rita, called Dr. John D. Franklin¹s office to make an appointment
> yesterday after getting a referral from our primary care physician.
> Although Dr. Franklin¹s name appears in the new UnitedHealthcare Directory,
> she was told they no longer accept UnitedHealthcare because they don¹t pay
> their bills.  Rita then called UnitedHealthcare to verify that Dr. Franklin
> was indeed no longer a participating physician and was told that he was
> still participating. After they called Dr. Franklin¹s office, she was told
> that indeed Dr. Franklin was no longer participating.
>  
> While she had the United Healthcare representative on the phone she asked
> why they haven¹t paid several claims filed for her and me by Dr. Bill M.
> Smith (our primary care physician).  She was told the claims were not paid
> because the claims were not filed correctly.  Rita asked what Dr. Smith¹s
> office needed to do to file them correctly.  She was told that if they were
> not filed correctly the first time, they could not be corrected and our
> physician would not be paid.  We would not be responsible, but the physician
> would not get their money no matter what they did.  Rita asked the
> representative that even if a minor mistake is made when filing a claim the
> first time there is nothing that can be done to correct a mistake ­ she was
> told no there was nothing that could be done.  When Rita told the
> representative that she was going to make sure that everyone at UT
> Chattanooga knew this information, the representative hung up on her (or for
> some unknown reason the connection was disconnected).
> 
> Question: Should Employees receive this kind of treatment and should
> physicians have to battle with the insurance company for fair reimbursement?
> 
> Leroy Fanning
> Health and Human Performance 
> 
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