![]() Some types of problems that can lead to filing a grievance include: Grievances don't involve problems related to approving or paying for Medicare Part D drugs. You need to file the grievance (complaint) within 60 calendar days of the item you want to complain about - whether by phone or writing to UnitedHealthcare.įiling a grievance isn't the same as a request for a coverage decision. This includes problems related to quality of care, waiting times, and the service you receive. The complaint process is only used for certain types of problems. Behavioral Health Plan, California (USBHPC), United Behavioral Health (UBH), or its affiliates.When will UnitedHealthcare give you an answer?Ī grievance is a complaint. Behavioral health products provided by U.S. Administrative services provided by OptumHealth Care Solutions, LLC, OptumRx, Oxford Health Plans LLC, United HealthCare Services, Inc., Tufts Health Freedom Plans Inc., or other affiliates. Health plan coverage provided by UnitedHealthcare of Arizona, Inc., UHC of California DBA UnitedHealthcare of California, UnitedHealthcare Benefits Plan of California, UnitedHealthcare of Colorado, Inc., UnitedHealthcare of the Mid-Atlantic, Inc., MAMSI Life and Health Insurance Company, UnitedHealthcare of New York, Inc., UnitedHealthcare Insurance Company of New York, UnitedHealthcare of Oklahoma, Inc., UnitedHealthcare of Oregon, Inc., UnitedHealthcare of Pennsylvania, Inc., UnitedHealthcare of Texas, Inc., UnitedHealthcare Benefits of Texas, Inc., UnitedHealthcare of Utah, Inc., UnitedHealthcare of Washington, Inc., Optimum Choice, Inc., Oxford Health Insurance, Inc., Oxford Health Plans (NJ), Oxford Health Plans (CT), Inc., All Savers Insurance Company, Tufts Health Freedom Insurance Company or other affiliates. ![]() Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. UnitedHealthcare uses a customized version of the Ingenix Claims Editing System known as iCES Clearinghouse (v 2.5.1) and Claims Editing System (CES) to process claims in accordance with UnitedHealthcare reimbursement policies. UnitedHealthcare may modify this reimbursement policy from time to time by publishing a new version of the policy on this Website however, the information presented in this policy is believed to be accurate and current as of the date of publication. Finally, this policy may not be implemented in exactly the same way on the different electronic claim processing systems used by UnitedHealthcare due to programming or other constraints however, UnitedHealthcare strives to minimize these variations. Further, the policy does not cover all issues related to reimbursement for services rendered to UnitedHealthcare enrollees as legislative mandates, the physician or other provider contract documents, the enrollee’s benefit coverage documents, and the Physician Manual all may supplement or, in some cases, supercede this policy. Accordingly, UnitedHealthcare may use reasonable discretion interpreting and applying this policy to services being delivered in a particular case. This information is intended to serve only as a general reference resource regarding UnitedHealthcare’s reimbursement policy for the services described and is not intended to address every aspect of a reimbursement situation. Coding methodology, industry-standard reimbursement logic, regulatory requirements, benefits design and other factors are considered in developing reimbursement policy. This reimbursement policy applies to all professionals who deliver health care services. References to CPT or other sources are for definitional purposes only and do not imply any right to reimbursement. This and other UnitedHealthcare reimbursement policies may use CPT, CMS or other coding methodologies from time to time. This reimbursement policy is intended to ensure that you are reimbursed based on the code that correctly describes the procedure performed. You are responsible for submission of accurate claims requests. IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY
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