04/29/2024

Payment Issues with UnitedHealthcare Dual Complete Plans

We are experiencing issues with payment from United Healthcare's Dual Complete Community Medicare advantage plans. The plan charges a deductible and co-insurance. Since the patient is on Medicaid we cannot collect from the patient. We have not been able to receive reimbursement from Medicaid directly on any of these plans - we have tried a few different ways and tried calling for assistance, without any luck. Are we billing this wrong? Are we able to collect this from the patient when they have these dual-complete plans?

If a patient is enrolled in any Dual Eligible Medicare Advantage plan, you are not allowed to collect anything from the patient. Eligibility should be checked through ePaces to confirm if a patient has traditional Medicaid or is enrolled in Managed Care through a Managed Long Term Care plan. They are responsible for covering any deductibles or coinsurance from the Dual Eligible Medicare Advantage plan. Payment will be made for services up to their allowed amount, and any balance needs to be written off and cannot be billed to the patient.