United Healthcare FAQ
What does Out of Network mean?
We are out of network with all United Healthcare plans. This means that we don’t file professional claims to them.
Commercial Plans (non-MCR):
You would be self-pay for your visits with us and receive a self-pay discount for services provided in our office. You would pay this rate on the date of service.
Medicare Plans:
You would be self-pay for your visits with us but instead of our discounted self-pay rate, we will only charge you for the amount that your Medicare plan allows. You would pay this rate on the date of service.
What if I need labs?
Both Commercial and Medicare Plans:
You are still able to have your labs drawn in our office because we use Quest for labs. They are still in your network and will file your tests to UHC.
What if I need a referral to a specialist or ultrasound or other testing?
Both Commercial and Medicare Plans:
Just as we have in the past, we will refer you to specialists and facilities that are participating with UHC. The referral process and relationship with those providers is exactly the same.
So UHC will not pay for anything? What if I have Out of Network benefits?
Both Commercial and Medicare Plans:
We would love to keep you as a patient and will be happy to help you complete a Member Claim Form to submit to UHC for any out of network benefits that you might have. We have the claim forms in our office and will help you complete your portion on the form. We will complete our portion, attach the service information and your receipt of payment and mail it for you to UHC. They will then contact you directly with an explanation of benefits and any reimbursement due to you.
What if I have a secondary plan that is not a UHC plan?
Both Commercial and Medicare Plans:
That’s a great question. In this case, you will be asked to sign an out of network notice with an estimate of the charges. As long as we are in network with the secondary plan, we will file a professional claim to your primary UHC plan. Once they have processed the claim, we will file the claim with your secondary plan. If any balance remains such as copay, co-insurance, or deductible, you will be responsible for that amount and receive a bill from our office.
What if UHC is my secondary plan?
Commercial Plans:
We will file a claim with your primary insurance plan and collect any copay, coinsurance or deductible amount that is your responsibility and provide you with a receipt for your payment. You will then be able to submit a Member Claim Form to UHC along with the receipt from your payment and the Explanation of Benefits (EOB) that you will receive from your primary insurance.
Medicare Plans:
If REGULAR Medicare is your primary we will file your claim to Medicare and they will automatically forward the claim to your secondary plan after they have processed it. If any balance remains such as copay, co-insurance, or deductible, you will be responsible for that amount and receive a bill from our office.
Is this UHC’s decision or DFM’s decision? Is this a permanent decision or can it change?
We cannot provide quality care to our patients with the reimbursement amounts that United Healthcare is proposing. We too are disappointed that they do not see the value of independent physician practices vs. large corporations. We are encouraging our patients to call the toll-free number on the back of your insurance card and express your displeasure to United Healthcare directly.
We hope that you will continue your medical care with our office and are available to assist if you have any further questions.
How much will I have to pay?
Each patient’s visit with us is tailored to their specific need, so the visit levels will vary in complexity. We will be happy to provide you with an ESTMATE of charges prior to being seen but ask that you understand that it is possible that your provider will choose a higher or lower level of visit or provide a service that we could not have known to include in the estimate prior to your visit.
Commercial Example:
An established patient level 4 visit charge is $222.00
The self-pay discounted rate is $159.00
During the visit, your provider performs an EKG. There would be an additional charge of $64.00 for the self-pay rate EKG. The total due at time of service = $223.00
Medicare Example:
An established patient level 4 visit charge is $222.00
The Medicare discounted rate is $122.93.
During the visit, your provider performs an EKG. There would be an additional charge of $13.80 for the EKG. The total due at time of service = $136.73