Insurance denying Anesthesiologists claims due to being OON and no PA for procedure but procedure itself is paid for by insurance

Hello. My insurance, Optum behavioral care (UHC) has been denying insurance claims for anesthesiologists with the EOB stating they are OON and DNA (Deny due to No Authorization).

I did not receive prior authorization for ECT but this was after the hospital's Prior Auth employee stating that no Prior Auth is needed for ECT anymore. She tried multiple times though and was told by my insurance company that no PA was needed, but when I spoke to insurance, the representative stated PA was needed. Either way, we moved forward.

I'm not sure what to think of the situation as the psychiatrist performing the procedures as well as the hospital facility itself was eventually paid by insurance but I am just starting to receive outstanding balances from the anesthesia team.

Can anyone confirm if there has been a recent change in ECT requiring PA? I'm in CA if that matters. Who should I contact to appeal these claims and what should I say?

(I also have Medi-Cal as secondary insurance)

submitted by /u/Blamaway
[comments]