CPAPtalk.com

Then you need to call UHC and ask them how to resubmit the claim because they processed it wrong. Ask what info they are missing, like code numbers etc. Ask if the DME billed the order the correct way- with all the correct codes included. Good luck, someone at UHC is processing your claims wrong.

Cardsfan wrote: ↑

Sat Mar 03, 2018 1:15 pm

Then you need to call UHC and ask them how to resubmit the claim because they processed it wrong. Ask what info they are missing, like code numbers etc. Ask if the DME billed the order the correct way- with all the correct codes included. Good luck, someone at UHC is processing your claims wrong.

Aren’t the codes for the individual pieces the same for every insurance company? For example, a filter is always coded as a filter, which is basically a replacment/consumable part, why than would the codes matter since it’s the same code it’s how it’s being interpreted right?

Does anyone here maybe have united health care choice ‘in network’ through group. If so would you kindly look at one of your eob’s for your cpap supplies, as well as your uhc info on dme through uhc’s portal (if it is the same plan and also says *250 per item 100% expenses than it should be the same) and enlighten me as to how your eob is worded, maybe that would give me some ammunition to go with .... I know everyone has different insurance but if anyone else has the same policy that reads the same info through uhcs portal perhaps you can help this sorted... thanks

What I think it boils down to is “cpap ACCESSORIES are not billed under the durable medical benefit” so the question to united should be how are dme accessories billed. With accessories and or replacment parts being the key wording ? Does that seem accurate... thoughts???

I think the advice to contact your state health insurance board is a good one. Hopefully they would be able to help you get this sorted.

Call Ins. co and ask them to explain it to you.

Cardsfan wrote: ↑

Sun Mar 04, 2018 4:56 pm

Call Ins. co and ask them to explain it to you.

If the insurance company wasn’t changing the explanation they give every time we call and get a 18 year old wet behind the years customer service moron I wouldn’t be asking advice on how to handle the insurance company on a message board.

Ask to talk to the "APPEAL a claim' dept. Or, for independent 3rd party review, contact Health and human services 1-888-393-2789. (I got this info, my myUHC.com from my plan. I had to go thru the "appeal a claim" process 2 times this year so far. Thy got things straightened out, finally.

Cardsfan wrote: ↑

Mon Mar 05, 2018 8:18 am

Ask to talk to the "APPEAL a claim' dept. Or, for independent 3rd party review, contact Health and human services 1-888-393-2789. (I got this info, my myUHC.com from my plan. I had to go thru the "appeal a claim" process 2 times this year so far. Thy got things straightened out, finally.

Thanks will do

Follow up ..


-I can not appeal until they bill me (paper bill with eob) even though it’s currently listed online so I now have my hands tied until 3/16 (most likely 3/20) when the eob should be mailed
-our benefits coordinator can’t get involved until they actually send the paper copy eob (I sooo love red tape)

I have learned so far...
Frequency and timeframe limits for DME repair or replacement are specified in the member specific benefit plan documents. Of which, our benefits coordinator will send us.

They (filters, masks etc) are coded as “accessories Used in conjunction with a dme good” and should be billed as accessories or replacment parts and not dme. Because my plan states they are covered at 100 percent I also have no copay for them since they are accessories and not actually considered supplies. I am also on the no deductible plan ‘in network’ on group insurance through united healthacare choice if that means anything to anyone ....

I will follow up again after the benefits coordinator gets involved/ if and when I follow an appeal /get the texas state insurance board involved..

Prettypistol wrote: ↑

Mon Mar 05, 2018 4:00 pm

They (filters, masks etc) are coded as “accessories Used in conjunction with a dme good” and should be billed as accessories or replacment parts and not dme. Because my plan states they are covered at 100 percent I also have no copay for them since they are accessories and not actually considered supplies.

I believe this will work out good for you. It's a shame you have to go through such.

You can call the DME provider Billing dept. and ask if your supplies were billed as accessories or replacement parts for DME, or if you supplies were billed as DME.

Cardsfan wrote: ↑

Mon Mar 05, 2018 5:53 pm

You can call the DME provider Billing dept. and ask if your supplies were billed as accessories or replacement parts for DME, or if you supplies were billed as DME.

If she is going to do that, she should ask which HCPCS codes were billed. https://www.directhomemedical.com/direc ... -page.html

If you have problems with health care insurance provided by your employer, please remember the insurance company is only the administrator. Please read your health care plan provided by your employer and follow it to the letter.
If the insurance that administers employer-provided insurance does not do what the employer's Summary Plan Description states - call your employer. If you do not gent anywhere call EBSA ERISA office of the federal Dept. of Labor for your state. You will find their number at the Department of Labor website under EBSA: https://www.dol.gov/agencies/ebsa/about ... al-offices.
You are paying for that insurance with your labor and with your paycheck deductions. They owe you. Health care insurance is not a benefit nor a grace of the employer - it is part of your employment contract.

Complain to EBSA about UHC and about the employer administrator. This employee who is the administrator has fiduciary duties to make the best use of resources for you, not to save money for their employer nor for the insurance. That is the law. Use it.

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