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Is United HealthCare/ACN Giving You the Runaround?
ACA Will Notify State Regulatory Authorities of UHC/ACN’s Non-Responsiveness to Providers Using Results from Latest Survey. Your Participation Is Vital.
ACA has received many complaints in recent months from DCs around the country reporting difficulties when trying to call for benefit information or to obtain pre-service approvals from United HealthCare (UHC) and ACN Group Inc.
A timely response is imperative when providers are waiting for benefit information or pre-service approvals from insurers and networks. To ensure that administrative delays do not compromise patient treatment, most states have laws governing the timeframe within which those performing utilization reviews must respond. These state laws have one purpose: to ensure timely access to necessary health care services.
If you are experiencing similar problems with UHC or ACN, please take a moment to help ACA gather the necessary data to present to state regulatory authorities by completing a brief online survey before April 13. The information will be used as evidence that UHC/ACN may be in violation of regulations governing timely responses. The survey, located at http://www.zoomerang.com/survey.zgi?p=WEB2264JG5EUDC, takes less than one minute to complete.
Be assured that, in the event that a regulatory agency asks ACA to submit the names of doctors affected by the delays, no provider names will be shared outside the ACA unless you indicate so on the survey by including your name and demographic information. Thank you for taking time to complete this short survey and allowing us to assist in safeguarding the care you provide.
Doctors Left Waiting
In some cases reported to ACA, doctors experienced delays in excess of 11 days in states where the insurance laws demand a response within three days or less.
Doctors are required to fax pre-service authorization forms to ACN, which in turn faxes back an approval. However, according to the reportsACA has received, the fax numbers provided are not working properly. Some DCs who have tried to call and report the fax problems have been put on hold for up to 45 minutes before they could speak to a company representative.
Moreover, according to the doctors, it appears that ACN does not consistently notify UHC when it receives notification forms. In some cases, UHC will deny payment, stating that the provider did not submit the notification forms in a timely manner—even when ACN has the forms in hand. This miscommunication forces doctors to appeal denials, delaying payment for an additional 30 days.
While ACN has notified providers of a recent communications problem with its phone company, doctors tell ACA that the delays have been going on for months. In the meantime, ACN has indicated that it will accept pre-service requests via several new fax lines; however, doctors report that the numbers provided also do not work. Though complaints have recently escalated,ACA’s records show that this issue has been a problem for well over a year.
In addition to asking doctors to complete the online survey, ACA encourages doctors to report problems with insurer responsiveness to their respective state departments of insurance immediately.
ACA members can send their insurance-related inquiries to email@example.com.