Statewide UHC/OPTUM Survey

We are addressing an issue brought to our attention by a large group of medical practices.  The issue involves claims filed on behalf of United Healthcare (UHC) patients. 

We have been advised that often, once the claims are filed, the medical practice receives a request for additional medical information, either from UHC or its utilization review entity, Optum.  

Subsequently, the practice calls to request the status of the claim based on the additional information submitted.  Regrettably, the practice is often advised that the records were not received.  Based on further discussion during the call, the practice is told the records were sent to an incorrect address. 

MSSNY has been interacting with UHC on behalf of our members in reference to this problem since June 2019.

Due to the length of this ongoing burden, MSSNY is now seeking assistance from the NYS Department of Financial Services (DFS).  Therefore, we are asking you for further information to address this matter.  DFS is regulatory authority over NYS regulated health plans/insurers.

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* 1. Are you familiar with the issue the UHC/Optum asking for medical records to continue with the processing of your claim?

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* 2. Once you sent your records, were you paid as billed? [If yes, proceed to end of survey thanks].

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* 3. Have you been told that you sent the records to the wrong address?  

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* 4. If Yes, do you have documentation to support this?

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* 5. Were you subsequently paid at a reduced rate?

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* 6. Was your claim denied?

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* 7. After the records were submitted, was your claim paid within 45 days?

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* 8. If NO, how long did it take to be paid or denied?

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* 9. Did you file a complaint with the Department of Financial Services (DFS)? 

[If YES, please answer question 10.  If NO, would you please submit your complaint to www.dfs.ny.gov/complaint ].

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* 10. Please indicate your DFS file case number, here:

Please remember,  NYS Law prohibits any retaliatory action against a physician for advocating in good faith on behalf of patients.  If you need more information about this matter, please email Rmcnally@mssny.org. Thank you for your time.
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