Wiki UHC Denying all claims as OON but Provider is IN network

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kpina613

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I own a small medical billing company. I have providers in all different specialties. Since the beginning of 2025, I have had many UHC claims come back and processed as out of network for multiple clients but these providers are all in network. I have uploaded information show their network status, have spoken with multiple reps with UHC provider relations who all confirm the providers are in network, and every time something comes back it is denied stating they are out of network. I have run into a road block with them and am at a loss for how to proceed to get these claims paid.

Provider specialties I am seeing it with currently are: BH counseling (LPC and LCSW), Psych Med Management (APRN, NP), and Primary care (NP and MD). Not all of the claims are being denied, some UHC claims process and others don't. I have been told it's the patient's plan but they have the same "plan" as others being processed as in network and have been told numerous times by UHC provider relations that the "plan" is in network with each of my providers.

If anyone else has experienced this and has a solution please reach out! I don't know where to go from here. Thanks!! :)
 
@kpina613 Have you had any luck with filing your complaint? Our office is also having issues with this insurance company. We have tried calling and using the online chat and nothing gets resolved.
 
stacidawn said:
@kpina613 Have you had any luck with filing your complaint? Our office is also having issues with this insurance company. We have tried calling and using the online chat and nothing gets resolved.
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I didn't file a complaint, I was hoping to try and resolve it with them. I was able to successfully get the appeal paid for one of my clients patients. However, all the new claims are still coming back OON. Obviously, appealing every single claim is not manageable. I think I will go ahead and start the process of filing this though. I will come back and update this post when I have more information.

I am sorry you guys are having issues as well, although it does make me feel better knowing I am not the only one. :)
 
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