Claim denials in error, says UnitedHealthcare

Stakeholders had sought clarification from the payer in response to provider concerns
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Friday, May 3, 2019

Editor's note: This story has been updated.

MINNEAPOLIS, Minn. – Recent confusion about whether UnitedHealthcare would pay for certain CPAP supplies was the result of a systems error, says the payer.

Providers in April received letters stating the insurer would not pay for “essential” supplies during the rental period for a CPAP device.

“We have not made any changes to our reimbursement policy for CPAP/PAP supplies,” said Tracey Lempner, director of communications. “We did discover that a CPAP code was incorrectly added to a policy update. As soon as we were aware of the error we corrected it and we are adjusting claims.  ”

Providers began seeing denials for claims as of April 1 with an effective date on the letter of Jan. 1, 2019.

“Providers who had claims denied should resubmit those claims for payment if they were denied incorrectly,” said Laura Williard, vice president of payer relations for AAHomecare, which reached out to UHC for clarification after hearing from multiple providers about the issue.

“It’s a big relief for providers and patients, too,” she said. “I was concerned people were going to stop providing those supplies to patients.”

Medicare guidelines, which payers typically follow, allow for supplies to be billed separately.

Bundling supplies with CPAP devices is also not realistic, says Williard.

“Sometimes patients need to try multiple masks to find the mask that works for them,” she said.