Over 150.000 insurance professionals and consumers come to the Insurance Forum every month. Click here to register for FREE

Go Back   Insurance Forum > Insurance Consumers Forum > Ask The Agents

Reply to United Healthcare Physical Therapy Pay Rate for Out of Network Question     
Old 04-18-2012, 02:35 PM   #1
New Member
 
Join Date: Oct 2011
Posts:13
State: marketpantry is an Insurance Agent from Undisclosed Location
United Healthcare Physical Therapy Pay Rate for Out of Network Question United Healthcare Physical Therapy Pay Rate for Out of Network Question
if I see an out of network provider do they accept whatever the physical therapist bills? This is to ask if a physical therapist bills 225 per visit does uhc base the amount they pay based on that or would they demand a lower rate say 100 max for the visit in total? If the max is 100 it would mean I only pay 50$ once my deductible is met If I have a 50% deductible for out of network providers
------------------------------------
  Reply With Quote to United Healthcare Physical Therapy Pay Rate for Out of Network Question

Old 04-18-2012, 03:22 PM   #3
Guru
 
Join Date: Dec 2010
Posts:749
State: leevena is an Insurance Agent from Undisclosed Location
United Healthcare Physical Therapy Pay Rate for Out of Network Question Re: United Healthcare Physical Therapy Pay Rate for Out of Network Question
Stibroker is right, you do not really want to go OON when an In-network is available. The amount of your out-of-pocket can be substantially more.

OON will have an allowable charge for the service, which often times is considerably lower than the actual cost. Assume the cost is $225 and the allowable is $100, the carrier will adjudicate the claim as being $100 and you will have not only the ded/oop costs, but the $125 difference in addition.
------------------------------------
  Reply With Quote to United Healthcare Physical Therapy Pay Rate for Out of Network Question
Old 04-19-2012, 07:04 PM   #4
New Member
 
Join Date: Oct 2011
Posts:13
State: marketpantry is an Insurance Agent from Undisclosed Location
United Healthcare Physical Therapy Pay Rate for Out of Network Question Re: United Healthcare Physical Therapy Pay Rate for Out of Network Question marketpantry is the thread starter for: United Healthcare Physical Therapy Pay Rate for Out of Network Question

Originally Posted by STIBROKER View Post
no.....don't do it....always stay in network.....
Originally Posted by leevena View Post
Stibroker is right, you do not really want to go OON when an In-network is available. The amount of your out-of-pocket can be substantially more.

OON will have an allowable charge for the service, which often times is considerably lower than the actual cost. Assume the cost is $225 and the allowable is $100, the carrier will adjudicate the claim as being $100 and you will have not only the ded/oop costs, but the $125 difference in addition.
the physical therapy that i need is very specialized. It is mostly a massage treatment. I have to get internal (anal) work done.

I spoke with my physical therapist office. There policy is to accept the rate the insurance allows. They bill 225 but if the rate the insurance company is willing to pay out is 100 then that is what it will be adjusted to. I will not have to pay the difference, only my share defined in the plan and of course the deductible. What I am concerned about is what rate the insurance company will accept. Would they accept the 225 rate or would they say that they will only accept going with a lower amount?


also, is it possible to get in network coverage for an out of network provider? I managed to do this withh blue cross after I proved that there was no one in network within 30 miles of where I lived?
------------------------------------
  Reply With Quote to United Healthcare Physical Therapy Pay Rate for Out of Network Question

Register Now for FREE!
To sign up for your FREE INSTANT account, please complete the form.

Username:
    Password:   Confirm Password:     E-Mail:   Confirm E-Mail:     
   
Question of the day:   Summer is hot and winter is I agree to forum rules 


Old 04-20-2012, 02:50 PM   #5
ABC
Guru
ABC on United Healthcare Physical Therapy Pay Rate for Out of Network Question - Insurance Forum
 
Join Date: Jun 2008
Posts:3,005
State: ABC is an Insurance Agent from Undisclosed Location
ABC is a member of 1000 posts VIP club
United Healthcare Physical Therapy Pay Rate for Out of Network Question Re: United Healthcare Physical Therapy Pay Rate for Out of Network Question
First off you should be speaking with your broker about these benefits.

2nd the UHC is going to apply the out of network charges to your out of network deductible and Co insurnace.

So you can submit out of network claims but do not expect any kind of reimbursement until hit the OOP Max out of network.

UHC has a very large national network so I would look again for an in network provider.

Ask your self why is the medical practice out of network? Since they are already willing to reduce their charges.

------------------------------------
Indiana Health Insurance
  Reply With Quote to United Healthcare Physical Therapy Pay Rate for Out of Network Question
Reply to United Healthcare Physical Therapy Pay Rate for Out of Network Question 

  Insurance Agent Forum > Insurance Forum > Insurance Consumers Forum > Ask The Agents




Similar Threads with United Healthcare Physical Therapy Pay Rate for Out of Network Question
Thread Thread Starter Forum Replies Last Post
EIULs and Missed Fortune honestagent Life Insurance Forum 70 08-28-2013 08:05 AM
United of Omaha to Raise Rates 40%? Crabcake Johnny Senior Insurance Forum 51 09-11-2012 09:37 AM
Out of Network Coverage Question- Kaiser Vs United Healthcare marketpantry Ask The Agents 5 02-23-2012 10:19 PM
AARP United Healthcare Med Sup Rate Increase The Rabbi Senior Insurance Forum 12 10-20-2011 08:25 PM
Medicare Cap on Physical Therapy insurance0707 Senior Insurance Forum 8 10-18-2011 02:04 AM
A Different Approach to Healthcare Reform johnkarnold Health Care Reform Forum 0 07-23-2009 09:59 PM



All times are GMT -5. The time now is 05:23 PM.

Forum enabled with vBulletin®
Copyright ©2000 - 2014, vBulletin Solutions, Inc.


Join the Forum - It's FREE

Share This Page



Weekly Poll

What is your main strategy for growing your insurance business ?