Hello, had a question that hopefully someone on here might be able to give better insight than this joke of a healthcare institution we sadly have.
I recently had my healthcare ENT provider submit a prior authorization for surgery to address my deviated septum. The ENT office and my United Healthcare Medicaid both confirmed it was approved, with the ENT office stating that on their end it appeared to be covered 100%. However, when I reached out to UHC to double check and confirm, they were evasive and wouldn't confirm if anything would be owed on my end, only that they would know for sure 30-45 days after they receive the claim.
Honestly this just feels like they're giving me the run around. Anyone here have a similar experience, and is there any website or resource that might be able to give me a definitive answer on what I may or may not owe out of pocket?
I've worked in healthcare billing for over 20 years.
Medicaid (or UHC Medicaid) will either cover or not cover at 100%. There is no deductible or out of pocket for these services. There is occasionally a nominal copay (less than $5). What the insurance is saying that they can quote you benefits, but they can't be certain of everything that is going to be billed. They have to see the actual service with diagnosis and be sure you are still on the insurance at the time of surgery, all those things.
If the provider doesn't give you a quote up front for what you would owe, they would not be able to charge you afterwards thanks to the No Surprises Act.
Lastly, in general, Medicaid providers are prohibited from billing their patients for anything that Medicaid does not cover.
tl;dr - you should be good to go.
Thank you so much! This puts me at ease.
I've had a procedure denied after pre-authorization but the doctor resubmitted. Slight hiccups happen. But no, you will not owe a cent. I've also had a major surgery covered at 100%. Congrats on having medicaid. Get it all done.
your last sentence surprised me. does it include vision clinic services? they talked me into some diagnostic imaging that medicaid would not pay for (i'm on fee for service medicaid, not UHC medicaid) but it does pay for exams and glasses every two years. i paid out of pocket bc i believed it was necessary and then they tried to sell me supplements based on the imaging results.
Unfortunately, it sounds like they may have taken advantage of you. They may have you sign something up front stating that you know it's not going to be covered and you will be responsible for payment.
I've only worked a little in vision, but this is how they make their money. Regular eye exams don't pay very well, but the profit margins on glasses, contacts is astronomical. They add in the extra testing to see if there is any other drops or medicines they may be able to sell you.
yeah. it was only $25 and i may have (don't remember, very likely did, they did tell me ahead the price) signed the waiver, but i didn't know about the No Surprises act.
i wish they wouldn't do that to the FFS medicaid folks - I only recently learned the difference between the medicaid my non disabled child having friends get, and the one i get (as a disabled childfree not yet retired person). My therapist even dropped all her FFS clients but kept her UHC Medicaid clients, citing she can't make a living from the reimbursements the medicaid they give to us disabled people and warned me that i'm gonna have a hell of a time finding a private practitioner therapist who will take it anymore, they're "fleeing medicaid in droves". Do I feel slightly discriminated for being disabled? yes. Do i have a choice? Not that i know of.
You're 100% right. I've been on non-disabled Medicaid when I didn't have a job and it's very difficult to find providers who will accept you -- or accept you in a reasonable time frame. "Dr. A. doesn't have any Medicaid appointments until late February."
Yet, the hospital will have to accept you when something goes majorly wrong. It's the awful system we live with.
yep, it's either Burrell or Mercy for me right now. I'm on waitlists. Sigh. thanks for your input, sorry to hijack this person's thread
here to help if I can.
Just hope it isn’t at SSM. Last I heard they had not reached an agreement and are cancelling surgeries and appointments for patients with any UHC insurance.
It’s with an affiliate of St. Luke’s, so I should be good there.