Looking to challenge United on reimbursement for out-of-network mental-health claims
Hello! Any help you can give would be much appreciated.
We’ve got United Choice Plus through my husband’s employer. We’ve got a bunch of mental-health bills for one of our kids, and her therapists are all out of network–yes, that was dumb, I know we’re not getting a lot of that money back, but I figured we’d be getting the 50% coinsurance after we hit the deductible. Only now I’m learning that United is only reimbursing “based on Medicare allowed amounts,” so when my kid’s therapist bills us $181.12 for a 45-minute therapy session (CPT code 90834), United is only counting $76.83 and denying the other $104.29.
I’m trying to figure out if I can challenge them on the “Medicare allowed amounts” issue. I’ve yet to find our particular statement of coverage (despite poking all around the website), but I won’t be surprised to find that language about Medicare buried somewhere in it. But if I go to the Physician Fee Schedule Search and put in CPT code 90834 and choose our MAC (Atlanta), I get a “facility price” of $90.35 and a “non facility price” of $102.44, neither of which United seems to be using. If I could make the argument that they’re undercounting, I stand a better chance of getting at least a little of our money back.
Is this a winnable argument? Anyone get any advice for me? (Other than “get an in-network therapist,” which, we’ll try, but it seems to be becoming harder and harder.)
