Join me as I Submit my United Healthcare Out of Network Claim

May 26th, 2010. By AbiK

The much-anticipated Notice of Proposed Settlement for the United Healthcare (UHC) class action lawsuit about Out-of-Network (OON) charges being improperly reimbursed has finally landed in my mailbox—perhaps yours, too.

Chances are, if you’ve received the UHC OON settlement notice, you glazed over it and tossed it aside while simultaneously feeling some sort of nagging inside—that nagging you feel when you know you should do something but it’s just too much of a pain in the ass to do it. Windexing the windows falls into this category as well. The difference between the windows and the UHC settlement though is that at least you KNOW how to do the windows; just try to figure out how to submit a claim for this settlement.

So I’m going to go through the process with you—yes, I’m going to fill out the paperwork and post about it so I can feel your pain and hopefully help you make sense of it all along the way. And so our little journey begins…

My UHC Out of Network Settlement Experience: DAY 1

The UHC OON Proposed Settlement in hand, I rip it open to find a sea of text that immediately starts to confuse me. It’s not the lawsuit I’m confused about—we’ve followed the AMA v. UHC class action. It’s what the heck I need to do now. So I force myself to read the hideously dense serif text and here’s what I need to do:

1. Ask myself, was I a United Healthcare Subscriber…

at all between March 15, 1994 through November 18, 2009? Ok, yes, I was.

2. How long do I have to submit a Claim Form for this?

(i.e., how long can I procrastinate?) I have until October 5, 2010 to submit a UHC settlement claim form. Seems like a lot of time, but not if all the writing in this thing means I’ve got legwork to do. So I need to…

3. Figure out which Claim Form to submit…

I can use either the “Simplified Claim Form for Subscribers” (option “Group A”) or the “Out of Pocket Subscriber Claimants” form (option “Group B”) or the “Subscriber Claims for Adjusted Bill Amounts Not Fully Paid by Subscriber Claimants” form (option “Group C”). There’s an option “Group D”, but that’s for providers only.

Somehow the “Simplified” option seems pretty simplified compared to the other wordy claimant groups. Kinda like that 1040-EZ form. But, in similar fashion, if you take the easy way out, you risk getting a smaller amount of dough from this settlement.

See, if you go with the Simplified option Group A form, your “recognized loss” will be $50 for each year of the class period that you were a UHC subscriber (ie, 1994-2009). Fifty dollars a year isn’t bad, but I know I’ve written checks worth a lot more than $50 to pay for my “Out of Pocket” OON charges. In order to try to recover that cash, it’s on to the option “Group B” form.

The Group B folks are able to recover 100% of their Out of Pocket amount—though 20% will be deducted—up to $2,000 over all my claims—to account for co-payments, co-insurance, or deductibles I would’ve owed anyway.

So onward.

Here’s where it gets a bit more complicated.

4. What do I need to submit if I go with option B, Out of Pocket Subscriber Claimants?

I need proof! I need my bills! My Statement of Benefit forms!

Sh!t.

I don’t have them.

Oh—but look! It says here, “For assistance as a Subscriber or Provider filing a Group B, C or D (D is for providers only) claim, you may request the Claims Administrator to send you certain information furnished by the Defendants…regarding the Covered Out-of-Network Services or Supplies you either received or provided from January 1, 2002 through May 28, 2010. However you must authorize the Claims Administrator to send you this information.”

Notice, the class period goes back to 1994; you can request information only back to 2002.

So, I call the Claims Adminstrator’s toll-free number. FYI, it’s 800-443-1073. I spoke with Matt. He tells me that the defandants were only able to provide records back to 2002. So for anything that pre-dates that, you’re on your own. You can either pray you’ve got the records, or you can try your doctor. Though neither of those options—at least for me—would probably yield much.

The Claims Information Request Authorization Form (which is available over at berdonclaims.com) is what I need to fill out in order to receive the information I’m looking for. I print it out, fill it out, and mail it. And now I wait.

Given that there is a bit of legwork involved if you’d like to submit a more “itemized” claim, I can’t urge you enough to get moving. It’s the end of May, and all your information needs to be submitted (postmarked!) by October 5, 2010. The time will fly.

So, more to come…hang with me.

Tags: OON, out of network, Out of Pocket, UHC, United Healthcare

This was posted on Wednesday, May 26th, 2010 at 4:00 pm and is filed under Drugs/Medical, Emerging Issues, Insurance, Settlement . Feel free to respond, or trackback. Read our comments policy.