Oct. 22, 2004

Response to physical exams not really fully covered

As an iPlan member, you have chosen a benefit plan design that gives you greater choice and control in managing your health care expenses. With a consumer directed health plan such as iPlan, you have become distinctly aware of what your health care dollars actually purchase -- something that is invisible to those in more traditional plans such as an EPO or PPO.

As a partner in the purchasing decision, the iPlan allows you to treat your health care the same as you would any other purchase. Questions you would normally ask when you purchase any consumer service should be asked of your doctor: How much will it cost? Are there any additional charges? What services will I receive for each charge? Then, you can make the decision whether you wish to purchase additional services, such as the "pre-physical."

While all of this makes logical sense, it still leaves you in the unfortunate predicament of being charged for a service you thought was included in your preventive physical. The information you received from United Healthcare is accurate: your provider must adjust the bill in order for the claim to be paid as preventive. In addition, you should understand that UHC cannot pay the claim as preventive if the provider refuses to submit it as such.

We appreciate your question as we continue to work with United Healthcare and our community providers to provide effective benefit plans, while maintaining quality and affordability.

--Ellen Fox, Benefits and Employment Services (HR-B)