United Healthcare has denied all claims this year for being "out of network" but they aren’t? What to do?

My employer switched to United Healthcare this year and thus far, they have been a nightmare for us to deal with. The highlights are as follows:

My daughter (age 3) had a 104 fever and needed to go to urgent care on Memorial Day. Our local hospital had an urgent care branch in our city and it was listed as In Network online. They are now claiming that the urgent care is the only urgent care location for this hospital in the county that isn't in network, but it has remained on their website as in network for the last two months. I was told that I should call to verify next time, but it was 8pm on Memorial Day when she spiked a fever, so obviously that wouldn't be possible when they are closed?!

My son visited our pediatrician's office. The group is listed as in-network, the provider says it's in-network, but because we saw a different pediatrician (also on the website as in-network), they are declining the claim for being out-of-network?

We did appeal these claims, but they quickly rejected the appeal. Any advice as to how to fight this? Is the only next step really to appeal to the state via an IMR?

submitted by /u/goldenglove
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