Guest guest Posted June 8, 2011 Report Share Posted June 8, 2011 As long as we are on the subject of United Healthcare, I want to continue to point out that when you negotiate a " network " contract with them, their terms (from what I am told-since I do not negotiate contracts on behalf of my clients) are non negotiable. While I am not a legal mind, I believe this is considered a Unilateral contract. If challenged, I believe Unilateral contracts are not enforceable, since one side has undue influence in advancing the terms of the agreement. That said, DO NOT rely on my word, seek legal counsel on the matter if you are not happy. On another note, I have noticed that United Healthcare is very slow to respond directly to Provider complaints. In our company, my staff works over the phone on verbal and written appeals. If those appeals are not responded to within a reasonable period (I would suggest 30 days, since some UHC networks have a 90 day statute of limitations), I have these escalated up to my attention and immediately write complaint letters to the state insurance commission of the provider involved. You can certainly go back to the source of the original department that you complained to, but my experience is that this only delays the process further. By complaining to the Insurance Commission, you are FORCING United Healthcare (or any other insurance company) to work on your issue RIGHT NOW! The BS stops and the payment process kicks in again. I have taken this approach because UHC works very slow to resolve issues and doesn't seem to really want to pay. The insurance commission will address your issues AND take an insurer to task. And while I cannot know every state insurance law, I believe that if enough complaints are lodged, an insurer will have undue scrutiny from state auditors and their lives will become a regulatory hell that they put providers through. I am hopeful that since an insurance company will not change their ways, a state regulatory commission might help them reconsider their how they do business. Okay, off my soapbox once more..., I apologize if some of you are getting sick of my 2c! Jim <///>< Rehab Management Services Cedar Rapids, IA Blah, Blah, Blah and so forth 319/892-0142 www.rehabmgmt.com UHC overpayment > > > > > Group. > > We are an out of network provider for United Health Care. > > Patients were seen over 12 months ago. UHC is now requesting partial reimbursement for services rendered and paid for at this clinic. Hard to believe, reason stated, they overpaid for services. > > Have any of you had similar requests? > > Did you respond? > > Is there a statute of limitations on such requests? > > Roll > PT Center of Ocean Springs > Ocean Springs, MS > www.ptcos.com > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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