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May 19th, 2018 - cbchun 1 

Not accepting insurance company at one site but not others?

I am an independent anesthesiologist, trying to do my own billing.

I have been having an incredibly difficult time billing a certain insurance carrier at one location (a private surgical suite). Can I not accept this insurance at this location, but accept/bill the insurance normally at other hospitals/ASCs?

Logistically, it could be doable--the private office could screen for that insurance and collect payment for me beforehand. But I'm not sure about the legal issues, or what obligation I have to those patients to process a claim for them.

Thank you.

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Jun 5th, 2018 - Roxanne W    1 

re: Not accepting insurance company at one site but not others?

Do you have a contract with this insurance company? You may need to add this service location to the contract.

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Jun 13th, 2018 - cbchun 1 

re: Not accepting insurance company at one site but not others?

I have been billing with UHC for years. It has only been in the last year or so that every cataract/eye procedure claim has been held up. I do work at a ophthalmology private office/ASC and so I wasn't sure if it was the procedures or the location. Recently, I have denials at other locations, so I think it is UHC and eye surgeries.

My claims are denied for additional records, usually multiple times and requesting the same records over and over. Then I have had a round of denials because my signature was "illegible". I have been denied because Optum (who process the claim reviews) says I need to submit a letter or appeal, only to have UHC tell me I actually don't need to submit a letter.

Both Optum and UHC tell me claim reviews are random, but **every** eye surgery claim has been denied/reviewed at least once--usually 2 or 3 times is average.

I have been speaking with UHC's managers and "advocates" and they have been no help whatsoever. They cannot tell me what is the problem or why all my claims are being flagged for multiple reviews. They have not indicated there is any problem with my credentials or contract.

So....the ophthalmologist's office can help me screen their surgery patients and flag those with UHC insurance. But I was wondering if I can selectively not accept UHC (for eye surgery at this location) or is it all or nothing? Do I have any obligation to help the patients recoup any payment from UHC?

Thank you.

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