I have pathology reports from Hospital A that I received under a charity care arrangement. They are for dermatology. The reports revealed skin cancer and I needed surgery, but the hospital fused to allow me to use their charity care for the surgery I might be taking a low wage job to try and get private employer group PPO health benefits. But the plan would be with UHC. If I already have the biopsy reports showing biopsy #1, biopsy #2, biopsy #3, biopsy #4 are basal cells and they require Mohs surgery, do I still have to wait months to set up an appointment with a dermatologist and then WAIT for a referral to see a Mohs specialist? Forget about the prior dermatologist who did the biopsies. He works for a large healthcare system that won't allow him to refer me outside of their network. If I literally have the pathology biopsies, can't a potential UHC in-network Mohs surgeon's office use that? Or does UHC ppo private group plan insurance and the participating Mohs doctor under UHC insurance require another dermatology referral, which would mean I'd have to wait many months just for that and delay the surgery I desperately need.

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!

In April 2024, I had a couple of procedures done, such as fillings, cleanings, root canals, and crowns. I was pregnant at the time, so I had to delay the crowning, but I had the imprints done beforehand. At my consultation appointment in April, my dentist reviewed the treatment plan and the costs. I knew that I would have to pay out of pocket for some of these procedures. When I went in for my first filling and root canal appointment, the office told me that my dental insurance didn't cover some of the costs. I knew this and was okay with whatever the updated pricing was. Paid $606 for the first appointment, and went on with my life. At the second appointment in May, I went in for the crown imprint, and at this appointment, I paid off the remainder of the treatment plan cost before I even got the services done (with the updated pricing that my EOB said wasn't covered). I paid $552 out of pocket. Several months later, in April of 2025, I kept on getting these calls with no sensible voice messages saying "this is a debt collector". No effort was made by my dentist over the year to let me know of this balance. I checked my dental insurance claims, and the claim was rejected for code D3910, which I knew was already rejected when I went in for my last appointment. Now I am confused why my dentist is saying that the insurance rejected it when I already paid off my balance. What should I do, and am I liable for the debt? Should I speak to the debt collector or the dental office? This was in California, and the insurance is with United Concordia. Not sure if this matters.

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?

I have United Health Care’s high deductible plan, which I chose vs the lower deductible when I started my job 3 months ago for the HSA and because I have no medical conditions and rarely see a doctor. I’ve developed neurological issues the last month that have required a doctor visit, MRI, and now a follow up and likely more testing with a specialist. The doctor visit was $177 after a discount and MRI was $621 after discount. Does insurance even with that plan really not pay anything more? My old plan through my old job was high deductible with HSA, but bills were still only $70. At the rate I’m going, my old and new HSAs will be drained well before I hit my deductible, so I won’t have money to pay the bills. I guess the short answer is the doctor offices won’t get paid until I have the money, but is there anything more I can do? I can’t imagine how expensive seeing a neurologist will be plus whatever tests they want even if in Network.

My Dr wants to enroll me in a weight loss support group program. I have a high deductible plan with UHC so I will essentially be paying out of pocket until I meet my annual deductible. Dr's office asked me to call my insurance to check if it's covered, and they told me the billing codes. UHC said it's covered, but the cost ranges from $30-250 (per 20 minute session) depending on what the provider charges. They will pay 90% after I meet my deductible. They say that they don't know how much a particular provider will charge. I asked my Dr what they would charge, and they said the price is set by the insurance company. Who is lying?

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?

I have a high deductible UnitedHealthcare plan through work and my primary care doc referred me to a local radiology clinic for a mammogram and ultrasound for a lump in my armpit (everything turned out okay). I got the bill the other day and almost choked, $635! I called UH and they said since it was billed as diagnostic and they don't offer any discounts, they only paid about $50 and I paid the rest, essentially it barely mattered that I had insurance. I am 35 so they aren't covered yet as preventative. Should I appeal this? It's so much money after being laid off for 7 months before.

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.