Canandaigua Surgical Care Recoups 4 Months of Claims with the Help of MSSNY’s Heather Lopez
“It is a crazy time to be working in healthcare. We are a small practice that prides itself in doing our due diligence to stay current on the changing payor policies, and after months of being unable to get anyone at United Health Care (UHC) to respond to my concern regarding my provider’s network status, our practice was frustrated. Monroe County Medical Society gave me the name of MSSNY’s Heather Lopez, who responded to me immediately and put me in touch with a Northeastern UHC Network Specialist. Heather determined that my provider was in the network without interruption and advised me to send reconsideration claims for claims paid during this error. Unfortunately, we still received out-of-network remits. There was still a problem.
I contacted Heather again and carbon-copied her in on my communication with UHC. We discovered that UHC had not correctly listed my provider participating on all lines. With Heather’s intervention, UHC has agreed to reprocess all claims since August 2022 to correct this. I am now hopeful that we will have a complete resolution. We had hit a wall with this matter, and Heather’s assistance was crucial. She restored our faith in humanity.”
