united HC, medicare complete

[mom205]

My dad has been perscribed PT (in home). UHC states this is covered but we can't find a company that will treat my dad.
When talking to the Home Health companies we were told that few companies accepted united because of "slow pay or no pay"
I am confused...Is my complaint with the Home Health co or united? If there is a contract between the ins and the Home Health agency are they not required to provide the services?
any opinions as to what I can do?
Thanks

[Amir Mostafaie]

Dear mom205,

If your father is on a network (which resembles PPO) plan, he should be able to obtain a provider directory from his UHC. Provider directories list in-network providers in every field. You can then choose a povider out of that list & proceed.
If he is on an HMO plan, his primary care physician (PCP) is usually responsible for finding in-network providers for services he needs.

Sincerely,

Amir Mostafaie  

  

[mom205]

Thanks for taking the time to respond to my question.
Dad is on an HMO. His PCP simply states that no one will take his insurance, United Medicare Complete.
Our PCP told me what companies she tried and advised me to contact them as well as UHC.
UHC gave me the names of Home Health Agencies that they contracted with but these companies refused UHC.
I am the first to admit that I know very little about how ins operate. I only see an elderly man who needs care but is unable to get it...we are going from bad to worse,
Once more I ask, if a home health co is contracted with United are they not required to provide the prescribed services?

thanks for your reply,

Mom205

[mle134]

If your loved one is on an HMO, you might try care management.  This is when nurses try to manage his case specially, and can arrange "managed care" contracts with non-participating providers.  Especially when you find limited coverage within your network for needed specialty services, most HMO's will manage care in this manner.  It sometimes mean another "hoop" for you to jump through in order to get services, and the claims are often handled outside regular payment channels, so may take longer to pay.

Another avenue is to report to UHC that contracted agencies are refusing to honor their contracts.  The providers agreed to accept the terms of payments per their contracts for the length of their contracts, and in most states should be legally obligated to honor these contracts...

The most common complaint I have heard about UHC is not "slow" to pay but that they give a very limited time frame for the provider to submit the claim, so the provider (the home health agency) would have to be diligent in claim submittal and followup.

Hope this helps....