TMA vs. United: Faulty Radiology Notification Program

In a press release last Tuesday, TMA outlined its efforts to hold UnitedHealthcare Accountable for what TMA believes to be an underhanded utilization review. According to TMA, the insurance company's radiology notification program requires physicians to "call United and explain the need for the procedure to a clinical person, and often talk to a physician as well. If they do that, they are then given a number that the radiologist performing the procedure can put on his or her claim for reimbursement. If the physician does not go through that process, and the radiologist performs the procedure, the radiologist likely will not be paid." TMA further explains that "United's program does not even meet the state requirements for utilization review."

The Texas Department of Insurance (TDI) has referred this program to the Enforcement Division where officials are urged "to review any claims denied because the ordering physician did not go through the process." This could carry some rather large prompt pay implications meaning that some physicians could be owed penalties. Stay tuned for updates.

Read: TMA Press Release