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Member Financial Responsibility - Chapter 10, 2019 UnitedHealthcare Administrative Guide

Members are responsible for paying their copayments, deductibles, and coinsurance. You can collect copayments at the time of service.

To determine the exact member responsibility, submit claims first and refer to the EOB or PRA when billing our members.

If you prefer to collect payment at time of service, you must make a good faith effort to estimate the member’s responsibility and collect no more than that amount at the time of services. You must help ensure the member has not exceeded their annual out-of-pocket maximum. Several tools on our website can help you determine member and health benefit plan responsibility, including Claim Estimator ( > Get a Claim/Procedure Cost Estimate) and eligibilityLink, which shows HRA balances. Claim Estimator is available only for professional commercial claims.

We may be able to process some claims while the member is still in your office. You can use the claim submission feature on after you render services. Within seconds, you receive a fully adjudicated claim that shows the benefit plan’s responsibility and the member’s responsibility. This helps promote accurate collections and avoid overpayment or underpayment situations.

If the member pays you more than the amount indicated on the EOB/PRA, you must refund the member.