Jennie’s Never-ending Claim
“When I joined the office, a UHC claim was already at least 8 months old and had been worked a few times but to no avail. It was a pretty straight forward denial of a crown, so it should have been an easy appeal. I contacted the insurance to be sure they had the appeal on file, but couldn’t get anyone who could access appeals. Every rep I got transferred me: first to medical, back to dental, back to medical. I finally ended up getting a fax line and address for appeals to submit a new one. I submitted it by both methods.
Two weeks later, still no one at UHC could help me with finding the appeal. This continued in this pattern for another 5 months, with me calling biweekly and speaking to a different rep that gave me different info each time. Meanwhile, I tried using the pre-authorization number on a new claim for the same service and it was denied for TIMELY FILING! I sent a letter with an image of the logo from the Insurance Commissioner of the state with an assurance that they would be my next stop. UHC finally paid and the office and patient got the benefit they were due!”