Billing issues predate UnitedHealthcare cyber attack

A longtime Carson City provider says that issues with UnitedHealthcare’s billing long predates the cyber attack which affected the company and its subsidiaries last month.

Dr. Patricia Davin has been in private practice for over four decades and said she’s never had so much trouble getting reimbursed from an insurance company.

“I’ve never seen anything like it,” she said. “I’ve had some delayed payments in over 40 years never encountered anything to equal this.

“This is the biggest file I have.”

She estimated she’s spent more than $50,000 in her time trying to get paid since United Medical Resources, a third-party administrator for UnitedHealthcare, was contracted with the state.

“It’s been beyond a problem,” she told The Record-Courier. “It has been horrific. I can’t even tell you what it has been like to deal with this.”

A clinical psychotherapist in private practice, in July 2022 she started trying to get reimbursed.

“It’s not uncommon to send paper claims by mail, I was given an address but didn’t receive a response,” she said.

That’s when she started calling. When she finally got through, a representative suggested faxing them, and then emailing them after she was told they didn’t receive the faxes either.

After she emailed them, apparently the faxes turned up so the claims were denied because they were considered duplicates.

“It seems like if you follow the directive to a tee, there shouldn’t be a problem only for them to deny those claims,” she said. “Not to mention what a huge ordeal it is to get someone on the phone in the claims department who knows something. It takes hours of time. In the last two years it has cost me $50,000 in my time spent dealing with this.”

Concerns about payments from UnitedHealthcare prompted Carson Tahoe Health to send a letter out to its customers saying it’s possible the Carson provider would have to stop accepting insurance from the company.

Carson Tahoe is in negotiations with United Health, which complicates what they can say about the issue.

“As an independent, nonprofit, community-based hospital we are earnestly working to resolve this situation and avoid impacting the people we serve,” said Community & Patient Experience Administrator Kitty McKay. “We encourage anyone potentially affected to reach out to their health insurance agent or representative and express their desire to remain in-network with Carson Tahoe Health.”

In the letter from CEO Michelle Joy, the hospital told patients that it has given notice to United Healthcare and its affiliates that payment issues have prompted it to cancel its contract with the company unless something is done to fix the system.

If that doesn’t occur, patients will have to find other providers who will take the insurance.

A UnitedHealthcare spokesperson told The Record-Courier that there is no change to the current contract as of now and members continue to have network access to the hospital.

“We are actively meeting with Carson Tahoe Regional Healthcare and are committed to continued good-faith discussions with the goal of ensuring the people we serve have continued access to the health system’s hospitals and providers.”

Davin filed a formal complaint with the Public Employee Benefit System regarding the issue.

“I don’t understand why they don’t have to answer to anyone,” Davin said. “The state of Nevada entered into a contract to provide insurance for their employees. Why aren’t they raising heck on this.”

For providers the issue is that they contract with insurers for services, according to Nevada Division of Insurance Chief Deputy Commissioner Todd Rich.

“Providers don’t have much recourse other than civil action as these are contractual issues,” he said. “It is disappointing as Nevada is challenged in having an adequate amount of medical providers.”

That’s an issue Davin raised, as well.

“It’s enough that we have a mental health crisis, and we have a shortage of therapists in Northern Nevada,” she said. “From my perspective their business model is to delay, frustrate, and wear people down to the point where they throw their hands up, which leaves patients blowing in the wind. The killer this is one of the largest health care providers in the world.”

Davin said that there has been a slight improvement in service.

“I’ve seen some improvement, but it is not resolved,” she said. “I still have claims that haven’t been paid for October, November and December 2023. They are paying some from February.”

On Feb. 21, a United Health Group affiliate, Change Healthcare suffered a cyberattack that affected payments to providers, including pharmacists across the country.

On Monday the company said it was releasing medical claims preparation software to health care providers.

“On March 15, the company restored Change Healthcare’s electronic payments platform and is proceeding with payer implementations,” the company said at unitedhealthgroup.com. “On March 7, the company restored 99 percent of Change Healthcare pharmacy network services and continues to work on remaining issues.”

Rich said that the state has been monitoring the progress of the attack and that the company has indicated it should be up and running.

“This attack has certainly demonstrated a vulnerability in the health care delivery system in the United States,” he said.