Hi Kathie, Thanks for the update!

Hi Elaine, Thanks for your comment–and yes, I believe you’re correct in your approach for filing–however, you may want to double-check at the 800 number listed in the post above. I’m still waiting for my “request for information” to show up in the mail…we’ll see…

Just got mine today and I mailed it within 24 hours of getting the initial lawsuit letter.

Hi Kathy–Good news! It's great to hear a "happy ending" in the midst of many stories that don't often turn out that way…all the best to you and your husband!

Hi George, Thanks for sharing this info! I did sort through the "first wave" of UHC EOBs last night–that was just to identify which claims fit into the class period (ie, years involved in this class action) and I separated out those that had out of network fees. Now, I have to go back and actually assess each line item and cross check it with the requested info UHC sent to me this week. Then on to filling out the claim form. It's moments like this that I'm glad the filing cutoff date is Oct. 5th…more to come…

Hi Debra, In terms of your daughter, for the time period in which she was on your policy, her out of network charges should be on your policy ID number–I know that was the case with minors on my policy. It's probably best to contact the claims administrator directly regarding your sister's ex-husband–that may not be quite as straightforward.

Hi Gayle, Thanks for the update–and also for the important tip on Group B filings being converted to Group A if denied as Group B;
If I go by the instructions on the UHC settlement claim form (ie, the notice of proposed settlement) then they'd like you to include any invoices from providers and EOBs as well, in addition to the cancelled checks, credit card statements or whatever proof that you paid the provider. Personally, I think they should've just required EOBs–after all, that's the beef–how they calculated OON charges–not whether you paid the providers or not. But that's my little beef with this process.
Finally, it's my understanding that you need to transfer the information to the claim form–they state there are additional forms available at the claims adminstrator's website if you need more space… Indeed, nothing is ever easy, but with the amount of settlement $$ some folks might be due with this one, it's probably worth it to fill out the paperwork as best as possible.

I was told the settlement only applied to claims where UNC and the other companies were the insurer; it did not apply where they just administrered the claims.

Hi Joyce, Thanks for sharing your question–I'm sure there are others who are in a similar position, acting as executor or executrix of a loved one's estate that may be affected by the UHC settlement. I'm not sure what Berdon did not understand–your question is pretty straightforward and a fairly common one for anyone who's been through settling an estate–but my guess is that you should be able to file a claim on your father's behalf. Someone at Berdon should be able to answer this question in a reasonable enough manner for you to proceed. I would try to contact them again and try to speak–again–with a supervisor or manager to just ensure that there is no additional information they require etc–but failing that, my guess is that you're left to go ahead and submit the claim with whatever information you're able to locate. Speaking of information, you are not alone in finding a limited amount of claims on the statement from Berdon. A number of readers have commented in similar fashion and I, myself, have received a statement from Berdon that only has a few of my claims that were OON for that time period. Fortunately I do have copies of a number of EOBs from that time, so I can at least compare the two and discern what discrepancies there are. Unfortunately, it appears that unless you have some personal records, it may be a challenge to get a complete listing of OON claims from Berdon/UHC.

Without a doubt, Joyce, info is missing. I've been on disability since 1997, had 3 surgeries in 2009 and have seen plenty doctors in between. My "report" came back with 1 visit.What a JOKE!!!!! When I spoke with Berdon rep I was told thats all they were provided with, sorry. I hope nobody re-signs up with these …….

Hi Robert, I think it's varied for everyone; I received mine about two months after I sent in the request–and I only sent it in by snail mail (aka, us postal service)–not by the methods you've used; perhaps some other readers have sent in a request for UHC EOB info via fax, email or the website and can share their experience as well…

Hi William, If I’m understanding your question, it doesn’t matter that you’re not in an HMO or PPO plan. All medical insurance plans contract with medical providers as either “in network” or “out of network”–and your policy benefits should clearly state what percentage of provider services will be covered by the plan, based on whether that provider is either in network or out of network. Which then sort of leads us to the answer to your second question: you most likely received the class action notice about the UHC settlement because you were a plan member at some time during the class period of this lawsuit (ie, the time period that the lawsuit covers).

Hi Joe, I'll try to answer your question as best as I can… If you paid your out of network provider in full, and the provider's bill had been submitted to UHC as a claim for processing (which I imagine it was as otherwise you wouldn't really have anything to submit), there should be an "Allowed Amount" somewhere on your Explanation of Benefits statement from UHC.
Without knowing much more detail or having your statement(s) in front of me, if you paid in FULL, and there was never any adjustment or reimbursement made, and, as I said, the bill went through UHC, then it would appear that the amount allowed by UHC would be ZERO–as they apparently paid nothing and you paid in full. But regardless, if UHC processed the claim, the date upon which the claim was processed is the "adjusted bill date"; the "adjusted bill amount"–according to what I've just stated above–would be the amount you paid in full; and the "Paid Portion of Adjusted Bill" would be the amount you paid, which was the whole thing.

If your bill did NOT go through UHC as a claim, there's nothing to submit; if it did go through UHC and they sent you an Explanation of Benefits (EOB) stating an "allowed amount" that they would cover, and also a net amount that you would then be responsible for, and yet you paid your provider the full amount, then it would appear that your provider still owes you some money–as either you or the provider should have received some benefits if UHC was accepting some of the charges as allowable.

In terms of boxes to check off, if the only bills you have that you're submitting on this claim are those in which you paid the provider in full and you never saw an adjusted bill from your provider, then yes, you'd leave that second box empty.

Keep in mind, I don't work for the claims administrator, so if you'd like to double-check any of this, you can always call Berdon claims at the number in the post above.

Hi shreyl, While I can't fully answer your question, I can tell you that in order to file a Group D claim, your Provider–not you–needs to submit as a Group D. Only providers can submit a Group D claim. So your best bet would perhaps be to contact your provider's billing department to try to work out what's in your best interest–note, I said YOUR best interest. Also, as I'm sure you're aware, the deadline for submitting your claim is looming (Oct 5)….and we're going into a weekend, so the sooner you have the discussion, the better… More importantly, it sounds like your daughter has been through a fair amount and I truly hope she is now doing well.

Hi Joe, Based on what you've outlined, I think you're on the right path–except I believe that your Adjusted Bill Amount and your Paid Portion of Adjusted Bill amount should be $300, not $200. Reason being, if you read the instructions on page 5 on the Notice of Proposed Settlement (ie, the claim form you were sent) under "Group B – Out of Pocket Subscriber Claimants", when your claim is processed, 20% will be subtracted from your "recognized loss" amount to account for co-payments and deductibles–meaning, you don't want to deduct the allowance for your deductible twice–once from what appeared on your explanation of benefits (EOB) and then again now when your claim is processed. And yes, any proof of payment you have, along with your EOB is what you should make copies of and send in along with your claim. I'd definitely suggest calling the claims administrator's 800# though just to make sure about what I've said above–it is trickier when you were "reimbursed" by UHC, vs. receiving an adjusted bill from your provider after your initial bill has already gone through UHC's assessment of what it will allow.