Unitedhealthcare Case Study
As a resolution analyst at UnitedHealthcare (UHC), over ninety percent of my decisions are based on evidence provided by providers’ and members’ health policy contract and UHC reimbursement policies. The health policy contract provides payment regulations on how to correctly make a decision of either a claim is to be denied, paid or if additional steps are required. In a case where a member is asserting that an out-of-network provider should be reimbursed in-network based on their research involves investigating beyond the member’s contract and UHC reimbursement policies to justify an overturn. If the member provides proofs such as a copy of the participating provider listing on UHC's website or the provider proper Tax ID to support their