Getting a claim settled
Updated: August 24, 2012 12:52PM
Dear Fixer: My in-network doctor wrote an order for me to get a mammogram, so I logged on to the United Healthcare website to look up in-network providers.
The closest one was a radiology practice in Arlington Heights.
I had my mammogram performed at that location and a claim was submitted to the insurance company.
Later, I received a letter from United Healthcare stating that I had gone to an out-of-network provider and they would only cover a small portion of the bill instead of all of it, as they normally would under preventative health services.
I filed an appeal, but it was denied.
I asked why they could deny my appeal when I clearly went to an in-network provider. I was told that the billing address submitted by the provider’s billing agent was an out-of-network billing address. As a consumer, I have no knowledge or control over what billing address is used. I used the online provider look-up tool on the insurance company’s website and went to an address they listed as being an in-network provider.
On their website, they are still listing this provider and address as an in-network facility for a mammogram.
Dear Kimberley: You told The Fixer you were so worried about this bill harming your credit record, you started sending $40 a month just to keep the debt collectors at bay.
You told us you think the problem arose because the radiology practice only read your mammogram — they didn’t take the pictures. That part apparently was handled by the hospital at the same address. But as a consumer, you felt you did your homework by using the insurer’s website to choose where to go. (You were wise to save screen-captures of the Web pages you looked at.)
We took all this to United Healthcare and asked if they could take another look at your case. Soon after, you got good news: They’re paying your claim in full and the website has been changed — which should help eliminate confusion for future patients.
Know any good businesses?
Longtime readers of this column know that at the end of each year we run your stories about businesses that go the extra mile to help consumers. Here’s another way to recognize businesses that try to make the Chicago marketplace more fair and ethical: the Better Business Bureau of Chicago and Northern Illinois Torch Awards for Marketplace Ethics.
Each year, the local BBB recognizes a handful of companies that they say exhibit high ethical standards in dealing with their customers, suppliers, shareholders, employees and communities.
If you know a business that fits the bill, go to chicago.bbb.org and click on the Torch Awards icon for an entry form and rules; or call (312) 832-0500. The deadline to nominate is Sept. 7.~~~~>~.