OON but Insurance is asking for records

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PikminOC

MD Attending Physician
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This has happened twice in the past month. I think it's United healthcare and unsure of the other one.

I am out of network, but they are asking for records. Have you ever had this happen? Do you get patient permission and then submit?
Are insurance companies getting stingy with OON now?

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United healthcare is notorious for requesting records in general far more than other insurance companies. If patients want to use their out of network benefits you should anticipate the possibility that they will ask for records in the same way as if you were in network. It should not happen routinely but it is to be expected. You should get the patient's consent as they may just wish to drop trying to use their OON benefits. the main issue will be if you have not been keeping documentation sufficient to pass an insurance companies test for the CPT codes you are billing.
 
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