Relax, pundits, I'm talking about United Healthcare, not the United States.

I'm in the middle of a long and obfuscated journey for the payment of a billing claim by my insurance company, mentioned above.  It began with a dislocated temporomandibular joint disc, which required an MRI for verification and assessment.  My first step was to go to United Healthcare's website and find an MRI place near home.  I went in on January 2nd.

First I hear from my mom that she received a notice from United Healthcare saying they would deny payment because the MRI place was not in her plan.  I do not live with my parents and I am not on their insurance plan - I have my own insurance plan from work - so it was rather odd that my mom would receive this notice.  After contacting the MRI place, it was revealed that they had accidentally entered the group ID instead of the subscriber ID, or something along those lines - an honest mistake which I find understandable.  What is wrong here is that this means UHC didn't actually have the appropriate information to find someone to bill - they just matched last names, and got the wrong person.  So in effect they sent my personal medical information to someone else - an act that I am pretty sure is illegal.

When I called the MRI place to verify that a wrong number was entered, they apologized for the mistake and resubmitted the claim.  I was a little concerned at this point, because I didn't know how much UHC was going to charge me - or if they would send me the same notice they sent my mom.

Well eventually I got the bill - and it was for two of the same procedure, with my co-pay coming to about $600.  Yikes.  My first concern was why there were two procedures on the bill, so I called the MRI place (if you notice, I'm being careful not to mention their name here, because they are actually reasonable people).  They explained that it was for the left and right sides, but the billing claims guy was sorry my insurance company had stuck me with so much and said I could just pay $300.  This is a much more reasonable amount, but I still thought something was up with UHC.

So I called them up and - surprise! - they say it was out of network.  I explained that this was either bullshit or that I was going to sue them because I found the place through their website (I actually didn't cuss or threaten them in anyway).  After a quick check, the customer service rep said that apparently the MRI place was in network, but the actual doctor's name was out of network, and the claim was filed under the doctor's name which caused the problem.  She told me this wouldn't be a problem, and they would just reprocess it with the MRI place's name instead.

Unfortunately, a few days ago I received a letter in the mail from UHC which stated "We reviewed the information and determined that the original claim wsa processed correctly.  As a result, no additional benefits are payable".  The reason was given as "The patient received services from a physician or other health care provider who was not in the network."

>.<

I couldn't believe I would actually have to call them again for the same reason - we hadn't made any progress at all.  This time the customer service rep said that since it was submitted under the doctor's name they couldn't reprocess it with a different name, so it had just been reprocessed with the doctor's name.  Way to go, UHC.  I was told I would have to contact the MRI place and have them resubmit it under the different name.

I just got off the phone with the MRI place - their billing claims' seemed genuinely shocked that they couldn't just change it to the name of the MRI place, and surprised that it would be submitted under the doctor's name, because their normal practice is to use the name of the MRI place.  He told me he would contact UHC to find out if he really needs to resubmit the claim, and if so, he will resubmit it.

That's pretty much where things stand now - three months after the MRI.  I still don't know how much I will have to pay, if anything.  I wish I could switch insurance providers though - this is ridiculous.