Dear sassy1785,
It is difficult to forecast the outcome of your appeal at this stage!
Below is some more pertinent information that can help you with the process;
- Does UHC record customer service calls? (Some Carriers record all customer service calls)
Is there a UHC contracted facility in the area & why did your Doctor's office choose the out-of-network one?
Was this facility ever in UHC network in the past?
If this facility was in-network at some point, when did it drop contract & why?
Why did your Doctor choose the facility to get your test done instead of an in-network facility?
Is there another facility with the name similar to the facility you used & is it possible that the UHC operator misunderstood your inquiry & based on that gave you wrong info?
Is there more than one UHC network in your area & is it possible that the UHC rep looked up the wrong network?
About the note logged in your account regarding your call; was it made by a fairly new representative? (New reps are more likely to make mistakes)
In my experience all of these facts could help you make a stronger case.
Wish you best of luck,
Amir Mostafaie
This happened to me once. A doctors office told me they were UHC, and it turns out they were only "pending" UHC providers (had applied to be UHC providers, not approved yet), so UHC refused that claim, and also would not cover a cardiac echo that doctor ordered.
On appeal, I demonstrated that any in network doctor would have ordered the same testing, and it was eventually approved.
Many of your questions were relevant and we will definitely work more info into our appeal based on them!! I do believe it will strengthen our case! Thank you so much. Nancy