United Health HSA's and Prescriptions

[mariemerganser]

Just curious if anyone knows if the following is normal and/or common practice. I've never heard of this before but I guess it's possible that I may just not know. I've sold several United HSA's (Silver HSA 100) off exchange this year. A few clients have called me as they have satisfied their deductibles but they are still required to pay in full at the pharmacy and then copy their receipt and submit the receipt to United for reimbursement. I called United to confirm that these clients have in fact met their deductibles and they have. They also confirmed that the clients do still need to pay for all prescriptions and submit claims for reimbursement. Anyone heard of this?

 

[Tkruger]

Just curious if anyone knows if the following is normal and/or common practice. I've never heard of this before but I guess it's possible that I may just not know. I've sold several United HSA's (Silver HSA 100) off exchange this year. A few clients have called me as they have satisfied their deductibles but they are still required to pay in full at the pharmacy and then copy their receipt and submit the receipt to United for reimbursement. I called United to confirm that these clients have in fact met their deductibles and they have. They also confirmed that the clients do still need to pay for all prescriptions and submit claims for reimbursement. Anyone heard of this?

I have a family in MS that heavily uses their coverage with UHC that is HSA eligible and last year they met MOOP and scripts are 100% covered no receipt situation.

So no, I can't say that I have heard of this.

 

[mariemerganser]

Thanks for your response. What you describe is how I have always known this type of coverage to work. The girl in claims at UHC told me that they've been following this practice for years but I've been selling these products for years and I've never ran into this. How long have you had your HSA? Is it possible that the plan works differently under the new United Healthcare Life Insurance Company name?

 

[kgmom219]

Just to confirm...they are using an in network pharmacy?

 

[mariemerganser]

Just to confirm...they are using an in network pharmacy?

Yes, good question.

 

[Tkruger]

Just to confirm...they are using an in network pharmacy?

UHC Doesn't offer out of network benefits for PD's on any of the HSA plans we've sold.

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And in looking into the HSA 100 plan in 3 states there is no prescription drug coverage at all, such as copays. I've also seen a trend with this in Small Group HSA 100 with UHC as well.

UHC Continues to have valid claims being denied along with billing and agent compensation issues.

What's probably happening is that UHC's systems aren't updating with the Pharmacy which is why UHC has requested the insured to send in the the recipt to get it corrected.

Hell, I had an issue yesterday with a hospital claiming that they don't take a carriers off exchange network when in reality they really do.

This all came to fruition when I had a client call me looking for help after we specifically verified that the provider was in network at the time of enrollment. Said clients husband had been to the ER twice both being submitted to the carrier and applied to the deductible and MOOP.

Provider still claims that they don't accept the coverage because it's OCare...or a HIX plan when it is not.

Nothing surprises me anymore.

 

[mariemerganser]

Nothing surprises me anymore.

Same here.

 

[Tkruger]

So did you get it figured out?