Affiliate Ppo
Fighting the insurance company?
My family has a ppo with united health. $580 a month, taken out of my husband’s check…I recently gave birth to our second child. I used a midwife. I called United Health 3 times asking if they would cover my out of network midwife. They said 3 TIMES that they would cover 70% of the fee of $4500. After we paid her, I sent in the claim and and we received $780 (70% of 4500 is $3100) When I called they said that “A non network health care provider or facility provided these services. Your claim has been paid based on your benefit plan, which uses rates established by the federal government for the Medicare program. If no medicare rate applies to these services, your claim was paid based on another available claim source developed by us or our affiliate or by an outside entity”
Ok. HELP anyone? I wrote an appeal but I don’t think i’m going to win. Is there anything else I can do to recover the amount that was promised??
Usually when you’re out of network, you ALSO have a deductible. I’m guessing they PAID 70%, AFTER the deductible for the out of network service.
But you’ll have to call them to be sure.
The ONLY way I know of getting around this, is to find out which IN network midwives are in their system. If there’s NO in network midwife, then you can appeal the decision, and request in network coverage based on lack of availability.
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