UHC Consent Form

Dear ECCO Medical Patients,

We are writing to inform you that based on your current insurance plan with UnitedHealthcare, there is a possibility that certain medical services, specifically those coded as 37252 and 37253, may not be covered by your insurance.

ECCO Medical follows all of UnitedHealthcare’s guidelines including obtaining prior authorization for full approval. Even when we've maximally complied, UnitedHealthcare may still deny payment, even when we provide evidence of maximum compliance.

What this means for you:

Potential out-of-pocket costs:
Depending on your plan details, you may be responsible for a significant portion of the cost for these services, including the full price of the codes 37252 and 37253 which is approximately $1,250.00

Prior authorization required:
In some cases, even if your insurance plan technically covers the service, you may need to obtain prior authorization from your insurance company before receiving treatment.

Contact your insurance company:
We strongly recommend reaching out to UnitedHealthcare directly to verify your coverage for the specific CPT codes relevant to your upcoming treatment plan.
Our schedulers can provide you with a list of the CPTs specific to your procedure.
The phone number for your insurance company should be listed on your insurance card.
You can also ask your insurance company how to proceed with a benefit appeal.

Discuss options with your provider:
Please discuss your concerns and potential cost implications with your healthcare provider to explore payment plan options.