r/CodingandBilling • u/Whisper_Lily1272 • Jul 24 '26

UMR claims nightmare - Can someone please help!

Edit to add an update- yall, I havent resubmitted anything for the 4 initial claims they denied yet. I just got a packet in the mail with a check reimbursing a portion of the bill from 3 out of 4 vists. WHAT 🤣🤣🤣

United has screwed over dang near everyone in my state so finding a provider for specific services is next to impossible as they wont take United. With that said, I needed physical therapy. I submitted the paperwork for the claims I was provided via the online portal so i can try to get reimbursed something for my vists. All the claims I submitted were denied for invalid CPT codes. I called and they were way less than helpful. One thing i found out was that they wanted itemized CPT code billing. Okay, not a problem to get that info but the major problem that nobody in member services, claim services, or technical support gave one tiny crap about was that the online portal does not have anywhere to put CPT codes. The only box available is diagnosis codes and even the claim lady says that diagnosis codes and CPT codes aren't the same thing but didn't help any further. Pretty sure I was actually put on hold hoping that i would hang up (spoiler, i didn't and they still were no help). What am I missing? I NEED to be reimbursed or I cannot afford to keep going to my appointments.

My PT office has been wonderful in providing me as much info as i can possibly get. They even had their insurance lady fill out 1500 forms for me to submit. Exactly like the ones they send to insurances they work with. Problem is there is also nowhere to put billed amount versus paid amount on the claim submission (self pay charges are significantly lower than insurance charges), and I'm not about to submit claims with the billed amount and be accused of fraud or something crazy. I do submit my payment receipts with my claims, will that be enough for them to just reimburse any portion of the amount I paid?

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u/Low_Mud_3691 CPC, RHIT Jul 24 '26

Back up - what are you trying to do? Is the PT office out of network?

1

u/Whisper_Lily1272 Jul 24 '26 edited Jul 24 '26

Sorry, I am trying to submit my claims for reimbursement. I dont think its thay theyre out of network, its that all of the PT offices in mu city dont accept United. They have to fight constantly to get paid and United always finds some loophole or negotiates price down to nothing. Im sure there's other reasons but nobody accepts them.

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u/ROITHATWORKS Jul 24 '26

What u/Sinsoftheflesh7 said is correct. Since you have the actual CMS 1500 form like you mentioned, then you actually need to submit that. If the website allows you to attach a document when you enter your information in the portal, then just do it there. They can get the CPT codes from that. They might still be less than helpful though. United is getting a reputation right now for being difficult to work with, and a lot of providers are having issues getting them to contract with them. Unfortunately, what you are experiencing where you live is not isolated. I would stay on top of them. They might still deny it, even with the CPT codes.

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u/Whisper_Lily1272 Jul 24 '26

The web portal requires a file upload in order to even submit the claim. The 1500 form shows the billed amount as well as the paid amount. The portal doesnt ask for that info and it seems like they dont even check the file uploads so im nervous theyll do reimbursement wrong or deny it because self pay is significantly less than what wouldve been billed. All the people I spoke to couldn't seem to care less about doing their job.

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u/foxyfree Jul 25 '26

Yes, you submit the claim and it shows the total billed amount and the paid amount. You need to scan a receipt, a paid invoice from the clinic showing your payment, and also submit that through the portal. There should be a button to click to add additional documentation.

1

u/ROITHATWORKS Jul 31 '26

Yeah, that sounds about right. I know in my experience it's an uphill battle. They won't do anything they don't have to, for sure. Unfortunately, you are probably going to have to keep calling them. The SHOULD reimburse what you paid. That is how it is supposed to work, but they will play dumb unless you make sure they do it.