UCH Reimbursement Rates

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psycho-matic

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I am not sure if this is the appropriate forum for this matter, but wanted to see if others have had a similar experience. I recently started a private practice and was already in-network with UHC. The standard rates they sent me are shockingly low. For example, a 99214 CPT code pays $33 and some change! That's less than what Medicaid pays in my state. How can providers afford to take UHC insurance if their rates are this low? Can I negotiate a higher rate? Thanks.

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Sometimes they have a "facility" vs "non facility" rate, I know BCBS has that in my region (although even their "facility" rate is only like 20-30 bucks less than non facility), likely because they're expecting to get hit with facility fees. So for instance if you're billing in a hospital clinic they typically try to charge insurance a facility fee on top of your E+M or psychotherapy codes.

That's still insanely low, like not even believable low. UHC pays almost 4x that for a 99214 in my area and I'm not in some high COL area. I mean any private insurance that's substantially below Medicare rates is basically not worth working with.
 
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As a solo PP, you can negotiate, but usually don't have much leverage. There are a few insurers who pay much lower than others for my codes, and I just refuse to be on their panels. My clinical slots are still full several months out, so it's not like I'm hurting for business in the portion of the PP.
 
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So question for y'all, is it legal to overcharge insurance patients? I mean like charging $150 cash on top of charging UHC, since rates are so low. I've always wondered that. Could one do that on the weekends, charging a premium fee as well?
 
So question for y'all, is it legal to overcharge insurance patients? I mean like charging $150 cash on top of charging UHC, since rates are so low. I've always wondered that. Could one do that on the weekends, charging a premium fee as well?
No you can't. Written in contract.
 
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So question for y'all, is it legal to overcharge insurance patients? I mean like charging $150 cash on top of charging UHC, since rates are so low. I've always wondered that. Could one do that on the weekends, charging a premium fee as well?

Drop UHC, if patients who have them as insurers want to pay you out of pocket, you can provide them with a superbill so they can get some reimbursement from UHC, and you get your fees.
 
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When I was with UHC in past, it was below medicare rates, but better than medicaid. I was getting quite the influx of UHC in that location, and was pretty much only person taking it, outside of the Big Box shops - which were backed out 6 months. My practice grew enough that I made decision to cut them out, and took several renditions of mailing/calling/faxing them that I was dropping them. I first tried saying, rates are poor, you got 30 days to fix this. Silence. Sent drop notice - several times - and then they immediately came back to me with a tiny fraction above medicare rates offer. I responded my leave notice still stands unless an offer of 2x-3x medicare is presented to me. Didn't happen. Even after the term date, it took them 6-9 months or longer to remove me from their directory.

Few patients called up saying you are in network I want in. We politely corrected, no we aren't, and thankfully I had my lists of communications to prove it, should there ever been any bigger issues later. Which there weren't, thankfully.

Only like 5%, of the UHC people stuck with me for cash pay. The exact number is in my private practice thread.

I had a Sleep Medicine doctor sublease from me in the past. Their UHC rates.... way, way, way better. Oh, and UHC, often does carve outs, too, and sends it to Optum or UBH, etc.

There is a reason why UHC is the largest publicly traded healthcare stock and issues dividends routinely. Cigna is a distant second...

@randomdoc1 takes UHC and has a 'magic recipe' to get higher rates, review her posts for your answers.
 
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UHC is the only reason I still pay for Alma. The rates they offer me are a joke so I'm credentialed through Alma. I've tried negotiating and they are, by far, the hardest to negotiate with. They kept sticking a 22 year old recent college grad as my contact person and kept giving generic canned responses when I try to negotiate. Impossible to get anyone on the phone. I eventually escalated it up as far as possible and still got canned responses.

I would drop them in a heartbeat if I could but there's a major tech employer near me that has UHC and they're my single biggest referral source so I would lose 50% of my patients if I dropped UHC.
 
UHC is the only reason I still pay for Alma. The rates they offer me are a joke so I'm credentialed through Alma. I've tried negotiating and they are, by far, the hardest to negotiate with. They kept sticking a 22 year old recent college grad as my contact person and kept giving generic canned responses when I try to negotiate. Impossible to get anyone on the phone. I eventually escalated it up as far as possible and still got canned responses.

I would drop them in a heartbeat if I could but there's a major tech employer near me that has UHC and they're my single biggest referral source so I would lose 50% of my patients if I dropped UHC.
which company is it? you can DM me if you like, I might have a suggestion.
 
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I spoke with an insurance consultant. They said some companies might mistakenly file your rates under general “behavioral health” plans (I.e. non physician mental health providers), when they should be using physician plans for compensation scales.

Perhaps they made this error? It is so out of the norm that I expect there must be some error for that to be the case.
 
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I spoke with an insurance consultant. They said some companies might mistakenly file your rates under general “behavioral health” plans (I.e. non physician mental health providers), when they should be using physician plans for compensation scales.

Perhaps they made this error? It is so out of the norm that I expect there must be some error for that to be the case.
For full disclosure, I'm a psych NP. I routinely monitor this forum and learn from the discussions. Even for an APRN, I'd argue the rates are absurdly low. Much lower than BCBS, Medicare and Arkansas Medicaid.
 
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