Free Bottom Line | March 01, 2008Insurer to Reimburse Mismanaged Claims Angela Foehl Author Notes Angela Foehl, director of private plans advocacy, can be reached at afoehl@asha.org.Angela Foehl, director of private plans advocacy, can be reached at afoehl@asha.org.× © 2008 American Speech-Language-Hearing Association Article Information Practice Management / Bottom Line Bottom Line | March 01, 2008 Insurer to Reimburse Mismanaged Claims The ASHA Leader, March 2008, Vol. 13, 1-7. doi:10.1044/leader.BML2.13032008.1 The ASHA Leader, March 2008, Vol. 13, 1-7. doi:10.1044/leader.BML2.13032008.1 View Article Figures Tables Supplemental Data Supplements Multimedia Share Email Twitter Facebook Pinterest Tools Get Citation Citation Foehl, A. (2008). Insurer to Reimburse Mismanaged Claims. The ASHA Leader, 13(3), 1-7. doi: 10.1044/leader.BML2.13032008.1. Download citation file: RIS (Zotero) EndNote BibTex Medlars ProCite RefWorks Reference Manager © 2018 American Speech-Language-Hearing Association × Alerts User Alerts You are adding an alert for: Insurer to Reimburse Mismanaged Claims You will receive an email whenever this article is corrected, updated, or cited in the literature. You can manage this and all other alerts in My Account The alert will be sent to: Confirm × Sign In or Create a free account to receive alerts. × Speech-language pathologists and audiologists are eligible for reimbursements for claims submitted to and erroneously processed by UnitedHealthcare Insurance Company’s (UHC) state plans under a multimillion-dollar settlement agreement with most state’s insurance regulators. The agreement follows an investigation by state insurance regulators initiated in 2004—through the National Association of Insurance Commissioners—as to whether UHC and 25 of its affiliated state health plans had fully reimbursed providers and plan beneficiaries to the extent that they were entitled. The agreement affects only commercial health care insurers who operate on UHC’s two core claim processing systems (UNET and Cosmos), and does not apply to Medicare, Medicaid, or self-insured businesses. Although UHC did not admit to violating any laws, it did agree to pay an assessment to each of the 36 regulatory bodies of states and the District of Columbia that were parties to the agreement (as of Aug. 31, 2007) to settle regulatory findings and to reimburse states for the cost of analyzing UHC’s market conduct. UHC must also reimburse providers and plan beneficiaries for erroneously processed claims. Providers’ and beneficiaries’ claims that were denied or partially paid due to administrative errors—including coverage determinations—are eligible for reimbursement. If UHC’s claim review results in approved, retroactive coverage, the beneficiary’s provider will then be entitled to reimbursement for the services rendered. UHC is obligated to reach out to providers with high-volume complaints or issues and resolve them. This settlement could result in corrective payments (plus interest, as allowed by state law) to providers who participated in a UHC health plan and rendered services dating back to 2004. It appears that providers do not have to initiate action to receive any funds due under this agreement, as UHC is required to investigate claims and make payments under the oversight of state insurance regulators. The agreement is in effect from Aug. 27, 2007, through Dec. 31, 2010. State regulators have signed on to this agreement in Alabama, Alaska, Arkansas, California, Connecticut, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Utah, Vermont, Virginia, West Virginia, and Wyoming. Both the regulator and the health care plan in a given state must be parties to the agreement for claims in that state to be subject to restitution. 0 Comments Submit a Comment Submit A Comment Name Comment Title Comment Could not validate captcha. Please try again. You have entered an invalid code Submit Cancel Thank you for submitting a comment on this article. Close This feature is available to Subscribers Only Sign In or Create an Account × FROM THIS ISSUE March 2008 Volume 13, Issue 3 ‹ Issue › ADVERTISING DISCLAIMER|ADVERTISE WITH US Related Articles Who Pays for IPP?Coordinated care and interprofessional practice can enhance patient outcomes. Though insurers don’t reimburse for these services, changes may be on the horizon. The ASHA Leader, December 2017, Vol. 22, 32-33. doi:10.1044/leader.BML.22122017.32 The Clinical Fellow Licensure ConundrumLicensure, billing and reimbursement for clinical fellows can differ among states and insurers. Here’s what you need to know. The ASHA Leader, November 2016, Vol. 21, 34-35. doi:10.1044/leader.OTP.21112016.34 How to Win Private Plan Appeals The ASHA Leader, August 2008, Vol. 13, 3-18. doi:10.1044/leader.BML.13102008.3 Use Your NumbersWhat’s essential to private practice success? A solid financial plan that you tweak based on what your practice spends and earns. The ASHA Leader, January 2018, Vol. 23, 42-49. doi:10.1044/leader.FTR1.23012018.42 A Scramble to Preserve MedicaidArkansas organizations work together to stop proposed cuts to Medicaid reimbursement and to preserve professional autonomy. The ASHA Leader, February 2018, Vol. 23, 46-47. doi:10.1044/leader.SOS.23022018.46 ADVERTISING DISCLAIMER|ADVERTISE WITH US Related Topics Practice Management