PT Providers: How is everyone doing with the new Med Advantage clinical submission requirements?

I've been at our PT practice on the admin side for almost 8 years, Manager for 7 of these years. I submitted on 15 of these type of patients last week for approval, with more to come this week. Some still haven't been processed yet. The Owner, billing and myself have had talks about dropping UHC in the past. This was the straw that broke the camel's back. The refusal to increase reimbursement for any providers in our area, where the initial exam reimburses at less than 50% of the other main carriers here is abysmal. We get reimbursed the same rates we were reimbursed when I started here nearly 8 years ago. Compare that to cost of living in Sept 2024 vs Jan 2017. Somehow we have a great staff and great PTs who understand this with regards to compensation. But enough is enough.

Anyone else dropping out of UHC as an in network provider (or has recently dropped out)? If you bill out of network, do you still have to submit for clinical submission? I've heard it both ways. Member services at UHC told me last week on the phone with one of our patients that we would still have to submit, but I was told by Optum we did not. I need to contact Optum again to verify where the truth lies (no pun intended).

submitted by /u/Zealousideal_Job5986
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