Claims from Virtual First Provider are being denied by UHC
TL;DR: I have a virtual first plan with UHC that uses the app Galileo. I used the app twice and both times UHC denied the bill for it. These visits should have been covered, but it seems like Galileo has billed incorrectly and perhaps set me up with a provider outside-of-network (which I do not understand how is possible). What can I do to ensure appeals for these denials go through? Is there anything else I can do to protect me?
I am located in Texas, and I have this plan with my wife. We do not have insurance through an employer, and we signed up for a plan on the Healthcare.gov Marketplace this year.
We signed up for a silver plan from United Healthcare that uses the virtual first provider, Galileo. Basically, Galileo is our primary care assigned by UHC. We thought this would be convenient, especially if we were traveling. However, it has turned into a nightmare. I have only used the application twice. The first time was to re-establish care for my asthma, which I thought would be simple as I only take one prescription medication for it. The app seemed simple. They asked me various questions. I filled out some survey. They got me a prescription. The second time was them asking to check up on my asthma and to continue my prescription.
Both of these claims were denied by UHC. The first one states the reason for the denial as:
The start and end dates do not correspond to the total units submitted for the procedure. The additional units are not covered. Your provider must submit a corrected claim with the appropriate units or date of service span and units.
The second was denied because:
The claim was processed using your network benefits. The facility, physician, or health care professional is not in the network. If a provider bills you for more than your coinsurance, copay, or deductible, please call us at the number on your ID card.
I am especially confused by this second one. I do not understand how Galileo set me up with a out-of-network provider when UHC has Galileo as my primary provider.
I contacted Galileo about both of these denied claims. They told me that the first claim was already corrected and resubmitted and was finalized on their end. They were resubmitting the second one as well.
I checked back in with UHC in a month, but they still show the claims as denied. I contacted UHC over the phone and after two phone calls, each lasting an hour long, they said what they could do was have me submit a verbal appeal for both denials.
I submitted the verbal appeal, stating that I used the virtual first app, Galileo, that UHC requires me to use for my plan for simple items that fall within the coverage of my plan. That I did not know how I could have received treatment out-of-network from the app that is supposed to be in-network. They told me to wait 30 days to hear back from the appeal.
I am worried though. I have no way of knowing if this appeal will fix things. Both of the people I spoke to on the phone with UHC just seemed like they had no idea what they were doing and were constantly putting me on hold. I got reference numbers for the appeals, but I have no way of using them for anything. I was having to clarify things constantly and they did not seem to understand me.
Myself: “Is this reference number for the first appeal or the second appeal?”
Help-line: “Yes.”
Myself: “Are you saying this reference number is for both?”
Help-line: “Yes, and the appeal number for the second is ####”.
Myself: “Wait so this second number is only for the second appeal and the first is for both?”
Help-line: “Yes”
Myself: “But why is there an appeal for both together and a second? Is there one for the first only?”
<Insert me getting more and more confused>
Furthermore, my wife recently contacted Galileo because she developed a headache that lasted a few weeks while camping. The claim for her talking to Galileo on their messenger system was also denied.
This was part rant, but I am hoping to hear if there is anything else I can do to protect us in this situation? Thank you.
