NicoleTownsend
New
- Messages
- 3
- Location
- Forked River, NJ
Our office is going crazy with these United Healthcare (Medicare Advantage Program) denials! I am hoping that someone else might be going through the same difficulty. We are a 3rd Party supplier/billing/coding company for DME supplies in nursing homes - generally when a patient finishes their Medicare Part A stay, and then supplies are billable under Med Part B.
To our understanding - the Medicare Advantage programs can change certain things like allowed amounts and physicians that they accept in-network, but in general must follow the Medicare guidelines in the NCD's and LCD's.
If this is the case, United Healthcare has gone rogue. We are consistently getting place of service and SNF denials for all supplies which are clearly covered under the LCD. At first it was only ostomy and urological supplies. UHC customer service reps just tell us that Medicare wouldn't cover it, and won't research the issue. We submitted appeals and were paid last year - and then they did overpayments on all of our appeals!
This month they started denying our enteral feeding claims (the bulk of our business). Tomorrow morning I plan to get as high up in customer service as I can, but we are hoping to find a bit of advice in the meantime. Thank you!
To our understanding - the Medicare Advantage programs can change certain things like allowed amounts and physicians that they accept in-network, but in general must follow the Medicare guidelines in the NCD's and LCD's.
If this is the case, United Healthcare has gone rogue. We are consistently getting place of service and SNF denials for all supplies which are clearly covered under the LCD. At first it was only ostomy and urological supplies. UHC customer service reps just tell us that Medicare wouldn't cover it, and won't research the issue. We submitted appeals and were paid last year - and then they did overpayments on all of our appeals!
This month they started denying our enteral feeding claims (the bulk of our business). Tomorrow morning I plan to get as high up in customer service as I can, but we are hoping to find a bit of advice in the meantime. Thank you!