We strive to help our patients in every way possible. And, that includes using their insurance for payment. Some of those insurance companies and policies however are not the best…
One insurance in particular is United Health Care, for their AARP Medicare Advantage plan. This insurance has a payer code of “Life1”. Sometimes – they pay – most of the time, we get a message that the coding for our services (those doctor codes used for billing and diagnosis) are not valid for their care.
The codes we use are very specific, and the covered codes are MANDATED by Medicare. So, we expect Medicare codes to be covered by those companies connected with Medicare.
One of the codes used for billing is “98941 – Chiropractic spinal adjustments, 3 or 4 regions.” It’s a standard code used by ALL insurance companies and is the code used when adjustments are made in the neck or mid back or low back or pelvic areas.
This company in particular is known for “deny, deny, deny” tactics to not pay claims. A recent news story reported the “United States Labor Department suing United Healthcare unit for non-payment and denial of claims.” Another news story in Bloomberg News Law: “Health insurer UnitedHealthcare is facing a class action alleging it used an artificial intelligence algorithm to wrongfully deny coverage to elderly people for care under their Medicare Advantage health policies.” Yet another story on NBC news: “‘Deny, deny, deny’: By rejecting claims, (UHC) Medicare Advantage plans threaten rural … patients.”
One Medicare requirement is that all visits (to be paid) are coded with an additional item, called a ‘modifier’. The main modifier is AT – meaning Active Treatment.
One of my patients questioned UHC about why they did not pay. Here is their response:
As you can see, the code is in fact the valid code with the valid modifier that Medicare MANDATES: (From the Centers for Medicare Services website (CMS.gov) – “Doctors of chiropractic are limited to billing three Current Procedural Terminology (CPT) codes under Medicare: 98940 (chiropractic manipulative treatment; spinal, one to two regions), 98941 (three to four regions), and 98942 (five regions).When submitting manipulation claims, doctors of chiropractic must use an Acute Treatment (AT) modifier to identify services that are active/corrective treatment of an acute or chronic subluxation.”
In following the information provided by my patient, I called UHC – they tell me they do not ‘adjudicate’ their own claims, they send them to OPTUM (another company). So – calling OPTUM – they cannot find the patient information in their system… please call UHC, and round and round.
It is becoming clear – even though we love our patients and want to provide care to them, we cannot continue taking this medicare advantage plan in particular.
What’s the final word for this rant? DO NOT USE UHC, especially AARP UHC for your medicare advantage plan carrier. They put your health at risk.