10/23/2023

Billing UnitedHealthcare SNP Dual Plan Patients

I have a patient with United Healthcare Dual Complete Plan 1 (HMO-POS D-SNP) with dental We send claim and get an EOB from United Healthcare which states that they applied payment to the patient deductible and then list that amount as Patient Responsibility. So we bill patient. Patient calls irate that we sent a bill and did not bill correctly because they were told by United Healthcare that they have no responsibility. We also get a call from United Healthcare saying we should not be billing patient. When asked "why does your EOB have a "Patient Responsibility", the rep has NO answer. Can you explain what is going on? Does patient have a responsibility? thank you

When a patient is enrolled in a SNP plan (regardless of the insurance company), they are a dual eligible patient. A SNP plan has a Medicare Advantage plan as primary and Medicaid coverage as secondary. Any patient responsibility (co-pay, co-insurance, or deductible) needs to be billed to Medicaid as secondary. While the EOB from UnitedHealthcare applied the allowed amount to patient responsibility, because they do not forward the information to the secondary insurance, the amount applied to the patient is meant to be billed to Medicaid since SNP patients cannot be balance billed.