Public Mediation

My Claim vs. United Health Care Oxford Dispute

B. Y. vs. United Health Care Oxford
PO Box 4178, Portland, Oregon, 97208-4178, United States
Amount Involved: $310.00
    • Status: In Negotiation
      This claim has posted for public comment and negotiation. It will remain posted until resolved to the claimant's satisfaction. Suggest a resolution to help these parties reach a settlement.
       (seeking public comment)
    • Claimant Seeks: View.
    • Claim #: 2012232
    • Amount Involved: 310.00
    • Filed On: Nov 19, 2015
    • Posted On: Nov 30, 2015
    • Complaint(s):
      • Overcharge or billing error
      • "I just feel ripped off."
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Statement of Claim
Complaints Involved (2) - View
Claimant says:
"First all relevant documents - indisputable - have been sent to United Health Care at the address provided above.

United Health Care contacted me, letter attached, stating I "may" be entitled to a monetary refund due to my having appointments with a doctor who was mistakenly listed as "in network" at the time I was his patient.

I responded, with indisputable documents which they received during the first week of November 2015.

In brief, the documents I've attached here are all the same as what I sent in to Oxford, a copy of their letter to me, proof of payment and purpose of 3 dates of service, and proof of payment of 1 prescription, along with a copy of said prescription.

I called the phone number given on the letter for status, and have been told it's "incomplete". No explanation of anything, just "incomplete".

I reached out for a phone call from them for an explanation of "incomplete" and was told within 3 business days. I received no phone call. I called again yesterday, November 18, 2015 and again only "incomplete" and no reason for no one calling me.

Incomplete is to me the same as "denied".

I've had it. I'm belive I'm entitled to all money paid to be refunded since I went to this doctor under false pretenses thinking and selecting him because he was listed as "in network"."
...
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Exhibits View
What Claimant Wants Hide
1. Refund: reimbursement of medical payments maid Jan 01, 2016 $310.00
Cash total : $310.00
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Respondent's Counteroffer

There has been no response to this claim from United Health Care Oxford. This claim will remain posted until resolved
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  • Question: by Jim Wicks (41 points) — Former Atip Intern, Occasional Contributor And Moderator
    • On: 12-02-2015
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  • To claimant: A question, just to be clear. You say United Healthcare received the requested documents from you during the first week of November, 2015, correct? United's notice to you says, "If you are entitled to a refund, you will receive payment within 30 days after submitting the information above." It's now the first week of December. You filed this PeopleClaim on November 19, 2015, which means you were ahead of schedule in wondering where your refund payment was, and they are not outside their stated timetable. When you phoned them November 18 (or earlier) and they said your case was "incomplete," there was no reason to doubt that it was not yet complete; they had not promised faster processing. Next week, the second week of December, would be the earliest you could say your refund had not been received on time. In other words, it was premature to assume your claim had been denied.

    Also important: notice in their letter that there is more to getting a refund than the doctor being out-of-network at the time of your service or listed incorrectly in their directory. United's stated third condition for refund eligibility is that you paid the provider more than the required co-payment. That would be something to find out: whether your payments were more than the minimum co-pay.
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