Member financial responsibility - Chapter 11, 2022 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 before 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 at > Get a Claim/Procedure Cost Estimate and by checking eligibility and benefits in the UnitedHealthcare Provider Portal, which shows HRA balances. Claim Estimator is available only for professional commercial claims.

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