UnitedHealthcare (UHC) is one of the biggest health insurance companies in the country. For 2015, they re-entered the Indiana market, offering individual and family health plans.
This was a welcome addition to the Indiana health insurance market. What set UHC apart from the other individual carriers, was the network. UnitedHealthcare Choice Plus (PPO), gives Hoosiers access to almost all of the medical providers in the state.
Having this type of access was key for families when they made their health insurance selection. To have all of the families doctors in network, was a huge relief.
There has been some issues with claims, not because of the network but because of the medical providers.
On the UHC ID Cards, there is an ID number and a group number. This has caused great confusion with medical providers because they continue to file claims to the group division instead of the individual division. If the medical providers would look at the back of the card, they would realize they need to file the claims with the individual division. This has caused confusion with many UHC policy holders because they are stilling getting Explanation Of Benefits (EOB) on the claims.
The EOB comes back and shows the UHC policy as not being enforced. This is because the group claims department is not integrated with the individual department. In fact they are two separate companies but owned under the same umbrella.
This is actually an easy fix, you just need to let the medical provider know, then they need to refile the claim under the individual policy number.
With any new health insurance offering, we see a learning period for the medical providers. This has a lot to do with communication from the carriers to the medical community. It’s a slow process because medical providers are concentrating on treating medical conditions and not claims administration.
