Philips (Raytel) & United Healthcare alert

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Cris N

Happy to be here.
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Jun 24, 2005
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I have been using Philips Remote for INR testing (was Raytel Cardiac) for 3 years. I received an EOB from United Healthcare on Saturday telling me that I owed the full amount of the last billing since I was not using an in-network provider. (Kind of funny since 3 years ago when I tried to get my InRatio thru QAS UHC said no purchase but let's have you use the service through Raytel).

I spent an hour on the phone with UHC this morning during which my blood pressure probably skyrocketed - jeesh, such incompetence. I got a major runaround. They told me the contract with Philips expired on 11/30/08.

Ultimately I spoke with someone at Philips (in Billing) who assured me that the contract had not expired - this has to do with the switchover from Raytel to Philips. They've apparently straightened it out with UHC but they are certainly expecting more people to surface with problems.

I was given permission to share the name & number of the Contract Manager at Philips who will deal with UHC: Doug McNiel - 800.367.1095 extension 254.
 
Yup, I started having this problem with Philips and UHC last spring. Philips changed the billing code from 81 to 11, or vice versa. I finally got disgusted and bought my own machine out of pocket.
 
I'm going to put on my UHC hat here. I just checked our database and found that Philips Remote Cardiac Services is contracted for many products, but I don't see most of the commercial products listed. My warning is that just because Philips says it is straightened out doesn't mean that it is. I would check again with UHC.

I work for UHC but don't home test. This is one of those things that I can never get a straight answer on.
 
I'm going to put on my UHC hat here. I just checked our database and found that Philips Remote Cardiac Services is contracted for many products, but I don't see most of the commercial products listed. My warning is that just because Philips says it is straightened out doesn't mean that it is. I would check again with UHC.

I work for UHC but don't home test. This is one of those things that I can never get a straight answer on.

Lisa, thanks for the heads up. I just got off the phone with UHC again (and oh, thank heavens, they let me take a survey and leave a recorded message about the service I've received!) and discovered that they're reviewing it. So... I feel like I'm caught between a rock and a hard place.

I guess it's a wait and see...
 
I have been using Philips Remote for INR testing (was Raytel Cardiac) for 3 years. I received an EOB from United Healthcare on Saturday telling me that I owed the full amount of the last billing since I was not using an in-network provider. (Kind of funny since 3 years ago when I tried to get my InRatio thru QAS UHC said no purchase but let's have you use the service through Raytel).

I spent an hour on the phone with UHC this morning during which my blood pressure probably skyrocketed - jeesh, such incompetence. I got a major runaround. They told me the contract with Philips expired on 11/30/08.

Ultimately I spoke with someone at Philips (in Billing) who assured me that the contract had not expired - this has to do with the switchover from Raytel to Philips. They've apparently straightened it out with UHC but they are certainly expecting more people to surface with problems.

I was given permission to share the name & number of the Contract Manager at Philips who will deal with UHC: Doug McNiel - 800.367.1095 extension 254.

Caught this this morning on the Today show regarding out of network providers and UHC and their parent company, Oxford. I don't know if it's applicable in any manner, but you might watch and see what you think.
http://today.msnbc.msn.com/id/26184891/vp/28635471#28635471
 
So that's why I'm not getting a raise this year!

Actually UnitedHealth Group is the parent company of Oxford, not the other way around. Oxford is a very small division, most in New York. This kind of article upsets me, not because it is my employer, but because I think there's an underlying agenda to move us to universal healthcare. I don't trust the media to report a lost dog, much less something important.

First, the patient chose to go out of network. That is her choice, but when you do that, you should know you will be paying more. That's the point of having in network negotiated rates - to get the best price for the member. Our rates are generally at least a 50% discount of what a provider would charge to someone without insurance, or someone out of network. Look at your EOB to see what your managed care company does for you. For instance, the negotiated rate for my INR is $2.02. LabCorp charges over $50 for this test. Without insurance, that is what I would pay.

Second, the majority of our clients are ASO, meaning we are NOT the payor. The employers are the payers. Saving money with contracted rates or lower out of network rates has no direct effect on UHC. If the costs to the payor increase, your premium increases. Someone has to pay for it after all.

Third, we all know that lots of cancer treatments are considered experimental and not covered by insurance. This will probably be true even with universal healthcare. It's too expensive to pay for all the experimental, non-proven stuff, many of which are later proven to not work or even be dangerous. Actually, if you can get through out of network cancer treatment owing only $46,000, you are probably doing good.

Last, Sloan-Kettering refuses to contract with most true managed care companies with true negotiated rates. They do have some arrangements, including one with UHC, but it is usually for only 10-20% discount off of whatever they decide to charge. They actually don't expect patients to pay all of the patient portion of the bill, and budget their "bad debt" to account for it, but if they get full payment, they certainly won't return it!

I'm not saying that our healthcare system is perfect. There are abuses on both sides, just like there are in all industries, even churches. However, my personal opinion is that it could be much worse!
 
None of that surprises me in the least. I've been dealing and fighting with Insurance companies since I first became sick back in 91. United is most definately not the only one doing that. It's a national problem, not something isolated.
 
So that's why I'm not getting a raise this year!

Actually UnitedHealth Group is the parent company of Oxford, not the other way around. Oxford is a very small division, most in New York. This kind of article upsets me, not because it is my employer, but because I think there's an underlying agenda to move us to universal healthcare. I don't trust the media to report a lost dog, much less something important.

First, the patient chose to go out of network. That is her choice, but when you do that, you should know you will be paying more. That's the point of having in network negotiated rates - to get the best price for the member. Our rates are generally at least a 50% discount of what a provider would charge to someone without insurance, or someone out of network. Look at your EOB to see what your managed care company does for you. For instance, the negotiated rate for my INR is $2.02. LabCorp charges over $50 for this test. Without insurance, that is what I would pay.

Second, the majority of our clients are ASO, meaning we are NOT the payor. The employers are the payers. Saving money with contracted rates or lower out of network rates has no direct effect on UHC. If the costs to the payor increase, your premium increases. Someone has to pay for it after all.

Third, we all know that lots of cancer treatments are considered experimental and not covered by insurance. This will probably be true even with universal healthcare. It's too expensive to pay for all the experimental, non-proven stuff, many of which are later proven to not work or even be dangerous. Actually, if you can get through out of network cancer treatment owing only $46,000, you are probably doing good.

Last, Sloan-Kettering refuses to contract with most true managed care companies with true negotiated rates. They do have some arrangements, including one with UHC, but it is usually for only 10-20% discount off of whatever they decide to charge. They actually don't expect patients to pay all of the patient portion of the bill, and budget their "bad debt" to account for it, but if they get full payment, they certainly won't return it!

I'm not saying that our healthcare system is perfect. There are abuses on both sides, just like there are in all industries, even churches. However, my personal opinion is that it could be much worse!



This reminds me, we have NJ (Horizon) BCBS all of the Philly hosp have been in netwrok for us. BUT NOW CHOP and U of P and our insurance talks "broke down" so they are no longer coverred. BUT to make it even MORE confusing, we HAVE a PPO SO IF we go to the main campuses IN PA we are still coverred as in network, because they are in network for the local BCBS in Camphill Pa, BUT we can't go to the satalite offices in NJ, because that is not in network. BUT all the other Horizon plan holders can NOT use any of the CHOP/U of P centers.

OF course we got letters from CHOP and Uof P blaming our insurance and we got letters from our insurance blaming the hospitals for negotiations ending
 
The whole insurance thing is horrible mess. I'm a state employee and quite frankly have incredibly good health insurance coverage. I've only had a couple of complaints and they were relatively minor. I had essentially no out of pocket for my OHS. I don't have any co-pays for dr appts, lab work, or anything. The worst thing that I encountered was a coding error that I never could get fixed. So in reality I've been relatively happy with UHC. But what's really bugging me is the decline in customer service - admittedly, not just with UHC - it's pervasive. No one I've talked with about this or a question I had regarding an upcoming cataract surgery for my husband seems to be willing to go above & beyond. If you don't know the right questions to ask, you can't get an answer.
 
Cris - You're right - they don't always go above and beyond. It's not necessarily because they're not willing though. Like CS departments in other industries, most are entry level people who work from a script. If your problem isn't on their script, they're at a loss. Also, like other industries, CS is sometimes located in other countries, and the people working the phones aren't even familiar with the American healthcare system. If you run into brick walls and you really have a problem (not just an annoyance), my suggestion is to call your provider. They have a protocol for dealing with issues and they have contacts that you don't have. Also, it's their job!

Another reason is that some companies have quotas for Customer Service. They must deal with X number of issues each day, or not leave anyone on hold for more than X number of minutes, so they have a tendency to handle the easy problems quickly and flub the others.

Also, as other industries, they have begun laying people off. Aetna and Cigna announced major layoffs recently. Fewer people, but just as much work, means some things aren't as efficient.

I know that we have new people at the top who have made a return to good Customer Service a priority. Getting a problem solved on the first call is a goal. However, this may mean that you are on hold longer while the person before you is having their problem solved. If so, put your phone on speaker phone or put on your Bluetooth and multitask!
 
Lisa, thanks for your perspective. I guess I'm still trying to adjust to how much US companies have changed the business of customer service. While I can understand the cost impact of keeping the business here and/or paying more to hire better qualified employees (not to mention the cost of health insurance :D) it's still frustrating to have to go through all the aggravation of getting help. Trying to properly navigate a phone tree can drive ya nuts!:confused:

Thanks, too, for reminding me about using the people hired to help me track down the info... I forget they're there for that purpose... seems to me, though, that the shoe is on the other foot - shouldn't they be telling us that they're advocates for us? Hmmm..... Need to check into that one.

Anyway, thanks again for your insights.
 
An update...

An update...

Well, after another phone call it's finally straightened out. UHC has finally recognized that Philips is in network and that they do, in fact, have a national contract with UHC. Apparently has something to do with a billing address - I guess they were supposed to somehow indicate that the Wisconsin billing address for Philips was the right one even though everything goes through Connecticut.
 
Yep. We send for loading the addresses that the provider gives us. If they use a different address, our system will kick it out as non-par. This is because there are providers who are par at certain addresses, but non-par at others, so we can't assume anything.

I'm glad you got it straightened out. Maybe I will try it now!
 
Yep. We send for loading the addresses that the provider gives us. If they use a different address, our system will kick it out as non-par. This is because there are providers who are par at certain addresses, but non-par at others, so we can't assume anything.

I'm glad you got it straightened out. Maybe I will try it now!

Hope it works out for you.
 

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