Medicare Advantage Plan Declares Bankruptcy, Consumers Caught in the Middle

Recently my parents received the following notice in the mail informing them that their Medicare Advantage plan from Universal Health Care was being terminated.

They quickly selected a new Medicare plan and moved on. However, their providers didn’t. They continued to receive bill after bill for a lab service that had been delivered while they were still covered by Universal, but the lab hadn’t submitted the claim until after Universal declared bankruptcy. I called the lab to let them know that Universal Health Care had declared bankruptcy, and they still continued to send bills.  I called again to tell them that Universal Health Care had declared bankruptcy, and they sent another bill. After repeating this cycle five times, each time on hold for over 15 minutes, I got frustrated and began researching the situation in earnest. I had tried to explain the situation to them multiple times, and they weren’t listening.

After doing a little digging, I discovered that the lab was in violation of their own contract, which states:

Section 3.6. Member Held Harmless. Provider hereby agrees that in no event, including, but not limited to, nonpayment by Health Plan, insolvency of Health Plan, or breach of this Agreement, shall Provider bill, charge, collect a deposit from, seek compensation, remuneration, or reimbursement from, or have any recourse against Members or persons other than Health Plan, Provider or persons acting on Member’s behalf for Covered Services provided pursuant to this Agreement.

 This got me wondering how many Universal Health Care customers have received bills from this lab and paid them unwittingly. If you’re a former customer of Universal, do not pay any bills denied or rejected by Universal without carefully checking the dates of service. If those dates were within the time you were covered and were for covered services, you shouldn’t pay anything.  The Order of Liquidation clearly states:

Section 4.10To any and all physicians and other health service providers under contract with or providing services to Universal HMO of Texas, Inc.:

Each of you are hereby restrained and enjoined from:

(a) Charging, billing, demanding or collecting payment from members, enrollees or beneficiaries of Universal HMO of Texas, Inc. in violation of any applicable statutory or contractual provisions; and

(b) Interfering with these proceedings or the Receiver or her designees.

If any healthcare provider continues to send you bills for services they provided that should have been paid by Universal, do not pay them. Inform them of the bankruptcy and the Order of Liquidation. If they continue to bill you, send them a notice in writing mentioning both their contractual obligation not to bill you and the injunction against billing you quoted above.

If they still persist, get an advocate on your side. Remember, we’ve always got your back!

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