UHC Processing OON Claims In-Network

I’m on UHC COBRA with Optum managing behavioral health claims – abbreviating this to UHC.

My provider canceled their contract with UHC. UHC stated that services would be covered as in-network for 90 days after the termination date. Every claim since the end of that 90 day grace period has still processed as in-network.

This is a problem because a) the provider is getting reimbursed instead of me, even though I pay OOP and b) UHC is reimbursing at the old in-network rate instead of the maximum allowed amount, which I should be getting because I’ve reached my OOP maximum. UHC is functionally paying out half of what they should, and not to the right person.

I’ve had the relevant claims reprocessed 3 times now and had 4 reps confirm that the provider is now OON. Nobody can explain to me why they keep processing as in-network, the reprocessing team doesn’t speak to members, and the claims are ineligible for appeals because they aren’t denials.

I’m pretty experienced at fighting insurance, but I feel cornered without the option to appeal. I’m still resolving a years-long dispute with Cigna because they stuck me in a reprocessing loop, and I don’t want that to happen here. Ideas?

submitted by /u/powerguayaba
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