United/Optum delaying/denying mental health claims

Advice

Have you been asked by United Health/Optum to provide detailed medical records before they will reimburse you for mental health care services?

Below is an article recently published on the Clear Health Care Blog. Apparently, as of May 1, 2024 United Health/Optum has begun a new program designed to delay and deny payments for mental health benefits. According to the benefits office at my husband’s law firm “Optum Behavioral Health implemented a new payment integrity program called “prepay review”. This change was applied across UHC entire book of business, but our department was not aware of this program.”

This usually happens with out-of-network claims, but also happened with my psychiatrist who is in-network. For out-of-network claims, the client typically pays the clinician for services and submits a superbill for partial reimbursement to United/Optum. Until this year, my claims were processed and paid in a timely manner. However, after submitting claims for the last four months, I received 14 letters (snail mail) informing me that my claims would not be paid unless my providers (my in-network psychiatrist and my out-of-network psychologist) submitted a huge trove of information which not only would take hours to compile but which also included my entire medical record.

I did not want to burden my very busy clinicians (who are also a full-time professors) with this and I definitely did not want my entire medical record to be released to a company that has proven so careless with patient information (see the Change Healthcare Hack), so last week I sent an email to the benefits department at my husband’s office. I told them I did not wish send the requested information but I still wanted to be reimbursed. I also informed them I was reaching out to various media outlets to get the story out (and I did).

The benefits person emailed me today to say that they spoke with the firm’s UHC account manager and that I could disregard the letters and expect the claims to be processed in about 10 days.

This is great-for me-but also leads to more questions. Why am I being exempted from this process? Are others being exempted? Does it matter if the United client is a law firm? What happens to someone on the ACA exchanges?