Complaint / review text:
I respectfully submit a request to appeal your decision to deny a claim made by UPMC Physician Services for the Service date of 3/1/2010 for Radiology services for a charge of $165. This service was provided at an in-network hospital, St. Margaret's. It was ordered by an in-network doctor. It was performed at his same hospital in preparation for surgery. All research indicates that it is both unsafe, and not best-practice to perform this particular surgery without first performing this X-ray.
I checked the UHC website prior to service to be sure that the hospital and the doctor were both in-network. Then I called the UHC phone help line to notify you that I would be having this surgery, and to double check that all charges would be covered in-network. I asked specifically about this x-ray, because I knew it had to be performed in order to proceed with the surgery. I was told by the United Healthcare rep that it should be covered, as it was scheduled to be performed at an in-network hospital and ordered by an in-network doctor.
Apparently the Radiologist who read the x-ray, whom I never saw, apparently is not an in-network physician. I was never told this nor consulted about this, nor was I notified of this at any time. I would not have any way of knowing that the x-ray that was taken at this in-network hospital would have been read by a doctor who was out-of-network doctor. Nor did I have any cause to reasonably suspect that any services that were provided to me at the in-network hospital would possibly be rendered by someone outside of the hospital, or outside of my network. I believe that I acted in good faith and made every possible effort to investigate whether all charges would be covered prior to surgery.
I chose this doctor and hospital specifically because they were in-network, even though two other out-of-network doctors had been recommended to me. I did this because I cannot afford to pay more than my insurance will cover. Please reconsider your decision in my favor, and reimburse for this service.