United Healtcare totally confused

[RobertF624103]

My wife and I have a United Healthcare (UHC) Advantage PPO plan. Before enrolling we did check, verbally with UHC and the physicians, on the physicians listed as being in the network. Once the fees were being charged two of the doctors were charging the out of network fees. I contacted the doctor offices and they advised they were just charging according to what UHC was advising. I contacted UHC, by email. They continued to advise the doctors were in network. UHC was placing the blame on the offices and that they needed to confirm with UHC that they were in network. UHC advised that their system, UHC's, shows they are in network. I then pointed out that the Explanation of Benefits I received indicated the out of network charges. UHC is advising that their system is showing them in network, however, they are allowing this to be billed at out of network rates. There have been multiple emails and a claim review involved. UHC is now advising it could be 3 to 6 months before they can officially respond. In the meantime, there are pending bills and charges. It appears that UHC has multiple data systems that are not properly linked together and very little oversight to confirm compliance. I do not feel that the average senior should have to deal with these types of problems, especially with a health plan endorsed by AARP. How is AARP working to ensure their reputation is not being dragged in the mud?

[GailL1]

@RobertF624103 wrote

It appears that UHC has multiple data systems that are not properly linked together and very little oversight to confirm compliance.

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Just for clarity - providers are contracted for different type of plans under the same insurer - so just make sure you are checking the network list for your EXACT plan [by name/location] especially for a MA plan.

Providers can change their network status at any time.  The NO SURPRISE ACT passed in 2022 fixed this problem for commercial and group plans but Medicare nor Medicaid were included in this law.

Rather under Medicare, CMS has rules that are suppose to be followed to advise beneficiaries of important changes to their plan(s) during the year.

Medicare Interactive.org - Notices that Medicare Advantage and Part D plans must send if they make c...

Good Luck 

[sktn77a]

Medicare Part C is still Medicare.  Medicare pays UHC for all of your medical care.  If anything at all isn't Kosher with your provider's billing, contact the Medicare Fraud Line - I think you'll find the issue gets sorted out much quicker that way!!!