Insurance reimbursement rates

Asked this question in the other general forum, but maybe it’s an expert question.

What is the United Healthcare in-network negotiated reimbursement rate for HCPCS code V5261, binaural digital BTE hearing aids?

Why not ask United Health Care.

I did. So far, I have in writing $2200, then $4400, then $2400 and now $2200 again. The problem is that nobody has been able to tell me if that is per single ear or for a pair of hearing aids. Now they are stone-walling, and I need evidence (from a provider or in-network patient) of what the negotiated rate is.

It’s worth about $600 in a claims adjustment, that is why I am asking for help.

I have heard of this kind of nonsense with insurance companies in the past. I also assume UHC has different levels of coverage based on your premiums, and where you live. Would it be possible to do a search online?

Or whatever your employer set up with them. My last employer covered a pair every 5 years up to $6000 total, minus a 10% copay.

My coverage is 80% up to $3000, but that’s not what’s in question. UHC network negotiated service rates are the same regardless of what your employer’s plan pays. UHC mis-processed my claim 4 times now, and they are saying that “network rates” are $2200 for two digital BTE hearing aids - I think that they are quoting the rate for a single hearing aid, but I need to prove it.

I would think your employer can provide you with a copy of your insurance booklet, or UHC certainly can

I have a copy of our company plan, but again that’s not what’s in question.

My max benefit is $3000 (company plan.) UHC is saying that the “contracted rate” with my audi is $2200 for a pair of hearing aids, so they only paid me $1760 (which is 80% of $2200). UHC is trying to say that my audi overcharged for the hearing aids, that no matter how high the quality of hearing aids, he is only allowed to charge me $2200 for a pair of hearing aids.

Ridiculous, I know, but I need some evidence that it’s wrong to reopen my claim.

I have a copy of our company plan, but again that’s not what’s in question.

My max benefit is $3000 (company plan.) UHC is saying that the “contracted rate” with my audi is $2200 for a pair of hearing aids, so they only paid me $1760 (which is 80% of $2200). UHC is trying to say that my audi overcharged for the hearing aids, that no matter how high the quality of hearing aids, he is only allowed to charge me $2200.

Ridiculous, I know, but I need some evidence that it’s wrong to reopen my claim.

Company benefit plans do not contain contracted rates between UHC and audiologists.

Well then I would ask the audiologist if what they say is true. It could be that he has some kind of agreement with UHC although the $2200 price does sound like it would be for one aid. I hope that when you say they paid you, you don’t mean they sent you a check to reimburse you and if so, you didn’t cash it. See what your audi says. Start there. Can’t imagine anyone making money agreeing to charge $2200 for two aids. There must be some kind of arbitration you can go through when you have a dispute like this with an insurance company.

Thanks everybody. This is getting interesting. United still has my claim all messed up, they think it’s for one hearing aid, they say that my “max benefit is 80% of my max benefit” - now they are telling me that the “network allowable” is 50% of whatever the audi wrote on my bill - this is getting more and more bizarre.

Oh - and I found out another in-network person from my company had a claim for $13,000 - and they paid it.

The two times I processed hearing aid claims through United Healthcare with my former employer I had to get HR involved to get UHC to sort out their mess.:o