United Healthcare Physical Therapy Pay Rate for Out of Network Question

[marketpantry]

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

 

[STIBROKER]

no.....don't do it....always stay in network.....

 

[leevena]

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.

 

[marketpantry]

no.....don't do it....always stay in network.....

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?

 

[ABC]

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.