United Healthcare Commercial Plans: Speech Pathology and Occupational Therapy

Jul 08, 2023

United Healthcare (UHC) is a commercial insurance plan in which reimbursement rates are often less desirable for clinicians and therapist. The reimbursement rate of UHC is a contracted rate with the company set by UHC based on other providers in the area. Our clinic receives a flat rate of $50 on our UHC commercial plans. 

What does a flat rate mean?
Most clinics are paid by the CPT code. So if you complete a swallow evaluation (92610) and a speech sound production evaluation (92524) on the same day of service during a 60 minute evaluation you are reimbursed the contracted rate, for us $50 for both codes. If you perform a 92610 in a 45 min session and a 92524 in the next 45 min session each session you are paid the $50 flat rate. This model creates a very challenging predicament for business owners. 

If I have a speech pathologist who wants to be paid $45-55 per hour they see a patient. That speech pathologist seeing that patient just lost the clinic money. The owner paid for prior authorization administrative time, registration administrative time, check in/out administrative time, the clinician, the EMR they are documenting on, the submission of the CMS1500 at ($0.33) if it is a clean submission and not rejected and rescheduling. 

What do I need to know about UHC Commercial?

They are tricky they like to deny services and not pay even with evidence of no authorization required or authorization in place. On the portal it is recommended to follow these steps:

1. Login

2. Click prior authorization by member ID and DOB

3. Check the CPT codes you plan to use at your clinic by your patient to determine if authorization is required. 

4. Copy and paste the decision ID: Dxxxxx in the authorization tab 

5. There may be times you will have 2-3 authorization you are inputting based on the codes that require or don't require authorization. 

Take Home Points:

1. UHC is one of the lowest payers in network with the highest amount of administrative work. 

2. UHC is one of the largest providers so if you are attempting to grow your clinic and have an efficient administrative team this may work for you. 

3. UHC verification and authorization takes time.

4. The clinic cannot collect more than your contracted amount between the payer UHC and the patient. So if the patient has a 20% coinsurance for our clinic the patient pays $10 and UHC pays $40. 

If managed correctly through times and staff education we believe you can impact and change these patients lives regardless of the low reimbursements.