Uhc Provider Directories

[ILUVSAILZ]

For several days have tried to get a clarification from UHC regarding providers in their HMO directories that do not contract with the hospital coordinated with the plan. Essentially, providers knowing full well they contract with one hospital and know a HMO plan contracts only with another should be disclosing this or UHC should be noting it to the agent- if not contracting the doctor? Sure the doc can see the member but he will not treat them in the plan hospital- or isn't this part of the enrollment process as well?

I can just see that E&O claim, and I'm so sure UHC would take the fall for it.

 

[YouGotMyMoney]

I can just see that E&O claim, and I'm so sure UHC would take the fall for it.

E & O claim for what?

Looks like you drank the koolaid and you've swallowed the blue pill.

Some people are way too paranoid about E & O claims....

 

[Josh]

Some people are way too paranoid about E & O claims....

Could not agree more!

 

[Bob_The_Insurance_Guy]

In Medicare, as in Major Medical, the consumer (beneficiary) must be the one to verify that the doctor, hospital, surgical center, nurse, anesthesiologist, orderly, janitor, and candy striper is in network. It is incumbent on the member, not the agent or the provider.

This is for scheduled procedures. For emergencies, under Federal Law, it is always considered in network.

 

[ILUVSAILZ]

The point being- THERE EXISTS FULL liability for the MA agent(s) enrolling members and verifying the provider/facility coordinate (as indictated in cert. & AHIP). Although the directory has providers listed, where I'm licensed those providers do not practice at the plan hospital- and should not have been contracted. Nevermind.

 

[YouGotMyMoney]

The point being- THERE EXISTS FULL liability for the MA agent(s) enrolling members and verifying the provider/facility coordinate (as indictated in cert. & AHIP). Although the directory has providers listed, where I'm licensed those providers do not practice at the plan hospital- and should not have been contracted. Nevermind.

Please dude, don't stroke out over this stuff...

 

[DS4]

For emergencies, under Federal Law, it is always considered in network.

Only after 6 months of telephones calls and written correspondence.
ER claims out of network, getting paid as in network, never get paid correctly the first time.