United Healthcare has announced a new national policy to discontinue direct payment to out of network providers. According to an article in the September 2006 issue of Private Payer News, the policy will be effective July 1, 2007. Under the “pay the enrollee program,” United Healthcare will direct out-of-network benefit checks to the insured member rather then non-participating providers.
Pay the Enrollee was implemented earlier this year in certain areas. Oxford Health Plans, a United Healthcare Company, implemented the policy on April 1, 2006. According to the Oxford web site announcement, Oxford may refuse to honor the assignment of benefits for claims from non participating providers pursuant to language in the Certificate of Coverage. If enrollees choose to receive treatment out-of-network, the claim reimbursement may be sent directly to the enrollee. In such cases, the non-participating provider will be instructed to bill the covered employee for services rendered. See www.oxhp.com/secure/materials/employer/ba_bulletin_spr_06.pdf for the Oxford Pay the Enrollee Announcement.
AppealTraining.com has a forum area established to discuss UnitedHealthcare claims and reimburesement issues. Please post any information or questions you have about this policy change in this area.
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