Retraction Language for UH Policy
By: Bellinger P. Moody, RHIA, CPC, CCP, CPC-I
Executive Vice President of Compliance

February 14, 2011

On February 11, 2011, an alert was sent announcing that Medac would no longer bill anesthesia for pain procedures to United Healthcare due to a recent change in United Healthcare’s anesthesia reimbursement policy.  After a careful review of United Healthcare’s policy terms, it has been determined that anesthesia services for pain procedures should be separately paid by United Healthcare.

Based on the policy language and definitions, the only instance where United Healthcare should deny anesthesia for pain procedures is when the anesthesiologist and pain physician are the same physician.  Where the anesthesiologist and pain physician have different tax identification numbers, United Healthcare should not deny the claims; however, United Healthcare may incorrectly deny claims where the anesthesiologist and pain physician are two different providers but share the same tax identification number.  In this situation, we will appeal all denials using United Healthcare’s own policy language to argue for reimbursement.

We will keep you updated on any issues or changes with the United Healthcare policy.

The information presented herein reflects general information that is current as of the date it was first published.  In light of changes that may occur in the health care regulatory and compliance environments, the author's presentation of this information might become outdated.  Please check with your individual legal and/or compliance advisor(s) prior to taking any significant actions based upon the information and advice presented.