I have Medicare as primary and United Healthcare as supplemental. I first purchased Ampatches and catheters from Austin Medical and was advised that they would bill Medicare, who would process the claim and forward billing to UHC with the balance not reimbursed by them. Two claims were made in this fashion during 2013 and I received checks from both Medicare and UHC.
In 2014, several clams for covered supplies were filed in the same manner. I did not expect any reimbursement on the first claim from UHC since my annual deductible had not been met. Later in the year, I contacted UHC when reimbursements were not forthcoming and was told that they were refusing secondary coverage on the basis that Austin Medical was not an “in network provider”. I appealed this action citing their 2013 reimbursements and failure to disclose a change in reimbursement practices for supplemental coverage. My appeal was rejected and I am contemplating making a request for an independent review and a possible complaint to the Wisconsin Insurance Commissioner. Has anyone had this experience with United Healthcare and were you able to get a satisfactory resolution?
Bill