When you go out of network, UHC will pay the provider the full Medicare Allowed Amount (MAA), the same thing the provider would be paid if your were under traditional Medicare plus a supplemental plan.? The IBM/UHC plan is different from most Advantage plans in this regard, which is probably why the provider is saying they will not accept out-of-network Advantage patients - they don't understand the details of the IBM plan.
When you go out of network, the provider may agree to send the bill to UHC on your behalf. In that case, it will look little different to you from going in-network.?? You pay the co-pay and UHC pays the rest.
Some providers may refuse to send the bill to UHC and ask you to pay them instead and get reimbursed by UHC.?? That's ok, but you should be careful not to pay a bill for more than the MAA, as UHC is saying that they will not pay more than that for a Medicare Participating Provider.? If they want you to pay up front, you should check with the billing office as to whether they will accept the MAA as payment in full. They should, since the law requires that Medicare Participating Providers must accept the MAA.
There are many IBM retirees who go out of network with no problems. When a provider is in a contract dispute, many will try and scare their patients into switching to a different insurance plan as a way to gain leverage in the contract negotiations.? Refusing to treat them as an out-of-network patient is another tactic they use.
