Urgent care provider “home base”?

I do medical billing for my partner who is a solo practitioner, so I feel like I know more about this than an average consumer and I’m still stumped.

We have United Healthcare PPO through my partner’s employer, which is state government. Never any issues with skimpy reimbursement.

My city is very small and has one urgent care under the umbrella of the biggest med school nearby, which happens to be in another state. The local hospital and associated clinics and labs wete branded with their emblem several years ago (let’s call it ABC Medical). Prior to this the local Hospital was something like “State Local Medical System”. I never received care at the urgent care described below before the rebranding to ABC Medical.

My son injured his knee in gym class in May. I took him to ABC Medical’s urgent care where they did an X-ray, diagnosed a sprain, wrote a gym class note and told us to get a brace from Walgreens.

In June, I rammed my elbow on a protruding roughed-in plumbing pipe hard enough that it woke me up that night. Went to ABC Medical Urgent Care, also received an X-ray, wrap, and a shot of some non-narcotic painkiller.

I should note, this urgent care is convenient enough that I have been there half a dozen times in the past few years. Stitches, slipped disc, minor injuries, even pre-surgical blood work in their attached lab. I have seen both of the providers in question in the past with no issue.

Both claims were denied. The billing department of ABC Medical Headquarters says denial was based on care limits (eg yearly appointments that happened more than once in 12 months). They tell me to call my insurance (UHC) and tell them it wasn’t a once-per-year appointment and to reconsider the claim.

UHC says both mine and my son’s appointments have a service location of “Lakeside Urgent Care” with the same address as ABC Medical’s address, but Lakeside is out of network, whereas ABC Medical is in network, at the same address. If I want them to pay, I need to ask ABC medical to submit a corrected claim with the correct name. I have never heard of Lakeside Urgent Care, but the service address is the same?

I call ABC Med Urgent Care, because by now ABC Billing HQ is closed, and they tell me that each of the revolving providers has a “home base” and that’s the facility name they bill under. Can’t help me that it isn’t seen as in-network, because it should all be under ABC medical.

WTF? I’m going in circles. Who is actually wrong here, and how can I fix this $400 mistake?

submitted by /u/Cultural_Extreme_245
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