Guest guest Posted May 22, 2012 Report Share Posted May 22, 2012 I have a patient that was listed with us for heart transplant prior to us receiving CMS certification. This patient has United Healthcare primary and Medicare Secondary. Originally when we first listed the patient UHC told us He would be considered Out of network since we are no a center of exellence with Optum Health. They did however state that he his transplant (once we received certification) would be paid at the Out of network rate of 50%. Now they are stating he has a Mandatory in network policy and if he chooses to stay on our list and subsequently gets the transplant UHC will deny the claim. My question is will his Medicare also deny or will they still pay 80% leaving the patient with 20% of charges? Quote Link to comment Share on other sites More sharing options...
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