AARP medicare claims are not showing

[TomT237341]

It's been 2 months now and there are 3 known claims that are not showing up and 1 claim that is showing up but it's still in process more than 60 days later. I called UHC medicare advantage and they said they haven't gotten the claims. I called both providers to verify they filled within a week and shows pending insurance. UHC representative called my providers to ask them to resubmitt the the claims. That was 2 weeks ago and still not showing as claims. Can someone please explain why this may be happening? 

[papawofboo]

You want the simple answer, here it is. Years ago the biggest complaint that people had was that the bag boy had put the eggs and bread in the bottom of the bag and put the gallon on milk on top. Guess what, that shoddy workmanship has worked its way into the medical field and all the other fields. Use to people went to work and did the best job possible, no more, over 90% of the people out there have the attitude, "That's good enough, let it go."

I have seen it take a year to get a claim filed  

My #1 rule is I don't pay until I have an EOB, that kind of gets the attention of the doctor's billing office. They in turn talk to the insurance dept. Then it all comes together, and you get an EOB. I'll bet you a nickel the problem is in your doc. office.

[Winter2025VA]

Papaw @papawofboo , that is wisdom!!!  👍

YOU WROTE: My #1 rule is I don't pay until I have an EOB, that kind of gets the attention of the doctor's billing office.

Take care,

Nicole  👵

[GailL1]

@papawofboo 

That ‘s kind of good advice but just make sure that the claims are yours.  I have been working on (2) separate beneficiaries who have had their Medicare claims compromise by DME fraudulent providers to the tune of $ 20,000 which Medicare paid them.  

The services were for those Continuous Glucose Monitors and the transmittal of data to the doc.  These transmissions are a big fraud area where lots of payments are being made to bad players (criminals).  

[papawofboo]

Way back I started having a calander for one purpose, medical appointments and visits. I takes so long on some of these claims, plus they may not always be filed under the name you know. You have to go by the date of service.

When you get your statement from insurance carrier always check to see if the charges are legit If not, start calling.

[Winter2025VA]

And Papaw @papawofboo , lol - especially the Medicare Tests have way too many hands being paid. Took me a hot minute to catch this. I luv my Wall Calender for ALL things as I DO NOT trust the electronic version my daughter luvs. Hmmm, what happens IF your cell gets stolen or the calendar or phone decides to have issues. Lol, now that I am old, I order the HUGE version from Amazon. Take care, Nicole  👵

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[*** @papawofboo wrote 4/14/25:

Way back I started having a calander for one purpose, medical appointments and visits. I takes so long on some of these claims, plus they may not always be filed under the name you know. You have to go by the date of service.

When you get your statement from insurance carrier always check to see if the charges are legit If not, start calling. ***]

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[GailL1]

If you have a UHC Medicare Advantage plan then you need to check with them on whatever the problem might be -  

Make sure the providers have your p;a name and account number correct and they know where to send the claim.  Make sure they are in your plans network unless your plan is a PPO and you are using them as out of network.  

There is nothing that AARP or Medicare (CMS) can do - your Medicare Plan is with United Health Care - it may bear the AARP name but that is just for marketing and royalty reasons - UHC processes all the claims.

[TomT237341]

These providers billed the UHC in January and were promptly paid. Now in February they don't show. When I called UHC, they said the providers didn't file a claim so called them and verified the claim was filled correctly so asked them to file again. Fast forward 2 weeks and they still are not showing. These are two separate providers so I find it hard to believe that they didn't file the claim correctly. Again, these providers filed claims in January and those claims went through and were paid. This has to be a problem with UHC. but there customer support continues to say they didn't get the claims. Soon those providers will bill me directly. I don't know what to do and neither does UHC. I'm just looking for some guidance here.

[papawofboo]

Just because Jan. was paid in Feb. is no sign that Feb is going to be paid in March. If you expect this to always be the case you are so going to be disappointed. Many reasons this does not happen, people out sick, people on vacation, etc. This year on one of my EOB's was a payment for a claim back in 2023. That is not a typing error it is a fact. Over 90% of the time a claim isn't paid is because it wasn't coded the correct way.

Let them bill you, just don't pay until you get an EOB. If you pay before the EOB then the insurance company pays and the doctors office owes you. Years ago I did this and it took almost a year before I got my money back. 

You want guidance, here is how I have handled it. After about 3 billings statements without insurance payments, I call the billing office. I tell them that this claim has not been filed with insurance and when I get an EOB telling me what I owe then I will pay that amount. Hang up and after everyone's filing and billing cycle the claim is paid. Remember this, insurance dept. doesn't bill, and all billing sees is a claim with an outstanding balance. 

[TomT237341]

You just don't get it, do you. It's April and the services from February are not being listed, never mind paid.

[papawofboo]

Yes I get it. Did you read about the claim from 2023 being paid in 2025. Look, you want to worry about something that you have no control over, go ahead. 

This isn't just a Medicare issue, I've had this happen way before I was on Medicare.  

[Winter2025VA]

Knock on wood Papaw @papawofboo , I have only had ONE issue since starting Medicare in 2023. Quest decided I OWED them about $100 for a test my Medicare Doctor TOLD ME was covered. I DO NOT care how much pain I may be in, I ALWAYS ask IF whatever he wants me to do is covered. Anyway, when I called Quest was told it was THEIR ERROR.  🙄

Take care,

Nicole  👵

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[*** @papawofboo wrote 4/15/25:

Just because Jan. was paid in Feb. is no sign that Feb is going to be paid in March. If you expect this to always be the case you are so going to be disappointed. Many reasons this does not happen, people out sick, people on vacation, etc. This year on one of my EOB's was a payment for a claim back in 2023. That is not a typing error it is a fact. Over 90% of the time a claim isn't paid is because it wasn't coded the correct way.

Let them bill you, just don't pay until you get an EOB. If you pay before the EOB then the insurance company pays and the doctors office owes you. Years ago I did this and it took almost a year before I got my money back. 

You want guidance, here is how I have handled it. After about 3 billings statements without insurance payments, I call the billing office. I tell them that this claim has not been filed with insurance and when I get an EOB telling me what I owe then I will pay that amount. Hang up and after everyone's filing and billing cycle the claim is paid. Remember this, insurance dept. doesn't bill, and all billing sees is a claim with an outstanding balance. ***]

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[GailL1]

@TomT237341 

Don’t show where???

You said the providers were paid - so what is the problem?  The providers are saying that they didn’t get paid?  

I am having a hard time understanding the problem ? 

[TomT237341]

UHC paid for services rendered in January. Nothing is paid for the February services.