This is an article from the New York Times and frankly after reading this I don’t think the folks trying assist the patient knew what to do.  This also goes to show you how very complex medical billing is.  The person at Optum would not give out the code? See what a difference 10 extra minutes of time makes and the code that goes with it to get a claim paid!  Interesting too with all the technology Optum boasts about all the time in the fact that the patient received a snail mail letter as well.  On the other side of the coin if you are the wife of a banker and the doctor files a $75,000.00 claim for a hammertoe procedure that normally runs between 10-15k, no problem check was sent right out.  It was an out of network visit too. 

$175,098.80 To Fix A Hammer Toe Billed by New York Podiatrist And the Insurer Paid It, Well Sort Of As They Sent the Check to the Patient By Accident, A New Investigation For “Out of Network” Charges Has Resulted

United Healthcare/Optum has so many subsidiaries anymore and they keep growing that their lawyers in this case didn’t even know the company sells anti fraud billing software, so they work it both ways.  The lap band case was somewhat entertaining as the United lawyer said they “have “ to depend on accurate billings from the doctors, again not even aware that United/Optum Insights has sold software that looks for fraud and errors in medical billing.

Lap band Surgeries Go Full Circle With Lawsuits–Now United Who’s Being Sued, Files Case Against Company Who Provided the Advertising and Services

So in this case the therapist couldn’t even get the correct code so you’re on your own if you run into complexities like this.  By the way here’s an archived post that might be worth a read to see all the types of businesses United is involved with today with the huge army of subsidiary companies they own.  That’s where all the action takes place today, in the subs.  BD 

Health Insurance Business Under the radar With Tiered Subsidiaries–Where All the Action Takes Place With Mergers, Acquisitions and Profit Centers-Subsidiary Watch

I have spent months trying to get reimbursed by Optum, a health services company that is part of UnitedHealth Group, for $2,500 worth of psychotherapy. I mailed claim forms twice last year, and both times the company said it didn’t receive them. I faxed the form, after an assurance from a representative that she would call as soon as it arrived. I’m not sure it did; I received no call. I tried submitting the form online. I kept landing on an “Error Occurred” window.

I filed a claim via email, but that produced only a snail mail letter from Optum denying the claim. Why? My therapist had used the wrong “code” on the form. Apparently, he used the code for 60 minutes of therapy. Optum will accept only the code for 45 or 50 minutes of therapy.

When I explained this to my therapist, he said he had no idea how to find the correct code. And here is the punch line: When I called Optum, a rep said he would not divulge the correct code. My therapist ought to know it already, he said. When my therapist called Optum, the company refused to share the code with him too.

This manager went on to say that in 2013, the American Psychological Association changed a number of Current Procedural Terminology codes, the numbers used as shorthand for treatment designations on claims forms. Mr. Request’s therapist was using the old code for 45 minutes of therapy instead of the new one.

So that explains why the claim was rejected. It doesn’t explain why a rep at Optum would not share the new code, or the company’s Fort Knox-like imperviousness to letters, emails and a fax.

If the system at Optum is as broken as this one patient suggests, you would expect an outpouring of animus toward the company on the Internet. And by gum, there is. At a site called Consumer Affairs, for instance, there are more than 500 reviews of Optum, most of them scathing. The words “horrible” and “horribly” get used a lot.


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