I went to an out of network Health specialist. I had 2 visits for around $200 per visit paid via credit card. They told me to send my invoice/receipt to my insurance company and they would reimburse me. I submitted 2 claims to United Healthcare and they were approved as out of network which went towards that deductible. I just assumed that after that approval, a check from UHC would be sent in the mail to me. It wasn’t. I chatted with UHC customer service today and they said to contact the health specialist business to resubmit the claim as in network. Talked to the specialist business representative and they don’t deal with insurance AT ALL. They are out of network for everyone and leave it to the patient/customer to handle insurance reimbursements if applicable. I’m at a loss for what to do now. I know I have to get it sorted with UHC but idk what to say or do at this point. How do I get reimbursed? Was I not supposed to submit a claim? Should I have gone through a different process and submitted something else? I’ve never had to deal with this kind of situation before and I cannot afford to not be reimbursed. Any tips or help would be much appreciated. Thank you!

I was referred by my PCP to a physical therapist and was going regularly to appointments where I was only charged a $15 copay. However, after one of my appointments where my PT used a new technique (biofeedback training), my insurance is saying that service is denied and trying to charge me upwards of $400 for this one appointment. My insurance provider is United Healthcare. When I go to their website and try to "estimate cost" of this procedure (code #90912) it says that it should be covered by my $15 copay. However, when I called United to ask why it was denied, they said that there was a form called a PRA that they sent to my provider and it was not returned, so they didn't have enough information and denied it. I was told by the provider, my PT, that she never got this form and I also reached out to the billing department for the medical group, Sutter, to have them try and follow up with insurance or look into it, and was told that they would and I'd hear back within 30-45 days. Now my insurance is saying that, since they denied my first appeal, I only had so long to appeal that and the deadline is approaching. The "patient advocate" told me that either myself or the provider has to write a letter to United Healthcare Escalation center and ask for a secondary appeal, but was super vague on what exactly to say or write. I called back Sutter, since it had taken so long. They said they had 30-45 "business days" to review it, but they'd mark it as highest priority. I don't think I should wait for them, but am unsure what exactly I can say to get United to resend these forms that my provider says she never received. Any guidance?

On March 11th, 2024, I had an outpatient surgery procedure done. Flash forward to today, April 8th, 2025 and I just received a bill for over $3000 for this surgery. The bill states that the surgery cost overall was $20,000 and my insurance at the time paid for ~$16,000. I was covered under United healthcare and this coverage ended about 5 months ago. Here are my questions: 1. Why am I just getting this bill now? Is this even legal? (I live in WI) 2. What would be the first step to getting this figured out?

Hi all - I was wondering what the likelihood that my Appeal that I finally sent in will be successful or if I'm just going to continue getting the runaround from United Healthcare. At this stage is it worth doing anything else (or do I have to wait until the Appeal plays out?) Some details... The claim that I filed with United Healthcare had all the correct, relevant, and necessary information including the in-network Tax ID, the Practice’s pertinent information, the doctor’s name, itemized receipts (two – one paid with FSA and one paid with credit card), and other pertinent claim-related information. United Healthcare processed the claim as out-of-network, but the Practice is in network, which made me receive +/- $3,000 less in reimbursement than I should have (due to that money going to an out-of-network deductible). I have called United Healthcare more than 15 times now across 3 months to see what else is needed and to fix the wrongly coded EOB and I’m always told that United Healthcare made a processing error and will fix it – but it never happens months and months later. The EOB erroneously states that this was an out of network event, but everything was in-network, and I have coverage for the procedure on my plan. Once again, every time I have called United Healthcare, they have told me that I’m right, that they are ‘backing out’ of the old claim and will fix it, and every time nothing has been fixed. I just called earlier this week, and the 15th advocate I spoke with (after taking 20 minutes to look over all the times I called and notes) said I was 100% absolutely correct, I should have received an EOB saying it was in-network, and the determination was wrong, but folks keep coding it – inexplicably – as out of network. She encouraged me to appeal....which I just did. Expectations of what may come next? Thank you.

So I have really bad neuropathy and have had for like 15 years. Can't feel anything below my knees. I developed a foot ulcer that was just not healing and after going to a foot specialist for 3 years my GP sent me to a wound specialist in Jan. My company had just switched to united health care so I wasn't very familiar with them. I went to the wound specialist every week or every other week for 2 months and I was actually seeing a lot of improvement and was feeling pretty good about it when my insurance told me they were denying a lot of the services so now I owe over $6,000! And this is on top of the $200 I had to pay every time just to go see him as a specialist. But the things that they are denying are things like the wound pad and the gauze that they wrapped my foot in for me to leave the office. The Doctor cuts away a lot of old flesh every time and its on the botton of my foot so am I just supposed to leave his office with a big open wound? Am I supposed to bring my own gauze? It's also saying that I got a device several times, but I never got any type of device. Also the amount that the doctor's office is charging for just a little bit of gauze is insane. It's saying that the gauze or pads are 16-48 sq in and they were just small squares so maybe my doctors office was padding the bill, but I'm not sure. I've tried appealing it but what else should I be doing? I've stopped seeing the doctor because I can't afford that so now I'm just back to not healing and having a constant worry that it's gonna get infected and I'm going to end up having my foot amputated. The claims say things like: Service description: A saline- or hydrogel-soaked gauze pad, 16-48 sq. In., used to cover a wound. The dressing protects the wound. Claim codes: Benefits for this service are denied. Your plan does not cover this medical supply, prosthetic, orthotic appliance, or durable medical equipment. Service description: Any one item used during a surgery. Claim codes: Benefits for this service are denied. Your plan does not cover this medical supply, prosthetic, orthotic appliance, or durable medical equipment. Please refer to the Exclusion and/or the Additional Coverage Details of your plan document for additional information. (CAD128) Service description Any sealant, protectant, moisturizer or ointment. The product is used no to protect nntont the the skin ckin against against tears tears or or breakdown breakdown caused caused by by tape or other adhesive material. Claim codes: Benefits for this service are denied. Your plan does not cover this medical supply, prosthetic, orthotic appliance, or durable medical equipment. Please refer to the Exclusion and/or the Additional Coverage Details of your plan document for additional information. (CAD128) Service description: A sterile pad, 16 sq. In. Or smaller, made of gel fibers to cover a wound. The pad is used as a protective dressing Claim codes: Benefits for this service are denied. Your plan does not cover this medical supply, prosthetic, orthotic appliance, or durable medical equipment. Please refer to the Exclusion and/or the Additional Coverage Details of your plan document for additional information. (CAD128)

I was insured through United Healthcare via my employer in Texas. My employer paid premiums monthly to cover the following month’s insurance (monthly payroll). On March 12, 2025, all employees were notified via work email that we were being placed on unpaid furlough effective immediately. We were told we would still be paid for work performed from March 1–11, with payroll running as usual at the end of the month. I didn’t hear anything else from my employer until April 2, when I received a letter in my personal email stating that we had all been officially terminated effective March 21, 2025. The issue is that I saw a specialist and had exams done on March 24, unaware that I had technically been laid off on March 21. The same day I received notice of separation (April 2), I called United Healthcare to check on my coverage. They told me my insurance appeared to be active and didn’t show any indication that it had ended. However, when I checked the United Healthcare app today (April 5), it now says my coverage ended March 21, and they have denied the claims from my March 24 visit. I had no way of knowing my coverage (or job) had ended at the time of the appointment. I’m concerned my employer backdated the termination or insurance cancellation, and I’m now stuck with bills for services I reasonably believed would be covered. Has anyone dealt with something like this before? What are my options here? Should coverage have continued through the end of March? Additional information: I have since found out my employer filed for bankruptcy, without letting any of us know, and none of the employees were paid for their time worked in March 1 - 11th. Any help or guidance would be appreciated I’m unsure how to navigate this situation.

Location: Wa State, USA Last month I went to the ER, while they there asked about billing insurance and I told them to use my state provided insurance which they had on file. Apparently they charged insurance from a provider from my old job which i haven’t worked at since December of last year. I never signed up for health insurance from my old employer. I did have dental through them at one point but that was it. Today i get a bill from United Healthcare that states i owe them $4300 from my hospital visit when I shouldn’t even have their insurance in the first place. I’m not sure where to start to get this resolved. My old employer? Hospital? Lawyer? I’m not even sure if this is the right sub for this but I’m just angry and confused so any help would be appreciated.

Is there a difference in how United Healthcare covers their insureds if it’s through the workplace vs the ACA (marketplace)? I currently have UHC through my work and it’s not as bad as people say. I’m thinking about retiring early and getting UHC via the marketplace but I’ve been reading there is a huge rate of denials or delays for basic care. Is there a difference between the two? Anyone had UHC via their work and then switched to the ACA UHC?

I am 20 years old and on my parents insurance. I got prescribed a medication under the impression that they would not be notified but my dad got a call about the prior authorization being approved and also a letter in the mail. Does anyone know how to change this/prevent this happening again in the future?