November 20 2015: For the last few works I have been consulting with therapists and patients on audits related to United Healthcare. I am sharing this information in the hope that it might save therapists and patients from going through some of the egregious issues I have seen first hand.
For patients who are insured by United Healthcare- You May Be Entitled to a Refund!! In accordance with an agreement reached with the Attorney General’s Office, if you were a patient who received care from an out of network provider who was inaccurately listed by UHC as in network, you can get a refund if you paid the provider more than the copayment or co insurance you were required to pay under your benefit plan, plus 12% interest!!
This applies to all dates of services from January 1 2006 though October 30, 2015. If you have any questions about this, or how to send in your claims for review, you can contact United HC directly at 877-276-7342 or you can contact the OAG directly at 800-428-9071 ( in NYS), or 518-776-2480 (out of NYState) or go to www.ag.ny.gov/bureau/health-care-bureau
Therapists who are in or out of network with United HC – WATCH OUT FOR audits and the “Recovery Services” team of Optum who are aggressively trying to classify therapy services either as medically unnecessary, or retroactively denying payment, and demanding refunds because documentations summited in audits ” did not support” payment or meet their standards. Here is a link to their policy and procedures on documentation– follow it very very carefully, and I recommend writing all notes in full sentences, not using any abbreviations and embedding specific time spent on each part of treatment for all timed CPT codes. In my 35 years in the field, I have never seen a more aggressive attempt to classify services that were rendered in the good faith that they would be paid for as “overpayments” with refunds demanded or taken from future payments.