Mail Handlers Health Insurance

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MHBP - Denial of Payment for Covered Services
Posted by on
Rating: 1/51
NEW LONDON, KENTUCKY -- MHBP has refused to pay benefits for a November 2011 MRI for my son. We went to an "in-network" provider and obtained pre authorization from MHBP prior to the procedure. After the procedure, MHBP denied the claim and indicated that the MRI was not medically necessary. I appealed the decision and submitted 27 pages of charts notes and letters from two of my son's doctors supporting medical necessity for the procedure. MHBP has denied the appeal. They also failed to respond to our appeal within 30 days and failed to provide copies of documents relevant to the denial (the timeline and copies of docs requirements are outlined in the "Plan Brochure").

Almost 60 days after filing the appeal, we have heard absolutely nothing from MHBP. We learned of the appeal denial by obtaining a copy of the denial from our son's provider.

This is most egregious of several MHBP claims denials for routine medical procedures or doctor visits. Thankfully, we have switched to another plan (GEHA) and are having no problems with denied claims. We continue to struggle to get MHBP to pay for 2011 claims involving covered services within-network providers. We would advise anyone purchasing health insurance to avoid this company. Dealing with them is an incredibly frustrating combination. They refuse to follow their own contract (The Plan Brochure) and are incompetent at the same time.
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User Replies:
clutzycook on 04/07/2012:
Did you have a referral from your son's PCP? Sometimes that makes all the difference in the world.
Anonymous on 04/07/2012:
Clutzy, MHBP is a PPO insurance. They don't require a dr's referral, but they do require a pre-auth.

Are you sure the authorization was approved before the procedure was done? Going to an in-network provider does not guarantee payment. MHBP also pays for out of network. What most likely happened is your ordering dr did not give enough clinical information and did not do a peer to peer with the MHBP dr. Also, they did respond to the appeal within 30 days. Your provider had a copy of it. Maybe MHBP has your address wrong? Did you file a second level appeal through OPM?
Stan on 03/03/2014:
These guys refuse to pay my Dr. for covered doctor visits. They are the WORST POS insurance out there. DO NOT PAY FOR THIS PLAN.
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Dr listed on site as in-network but billed as out of network
Posted by on
P.O.BOX 8402, KENTUCKY -- After moving to a new town I consulted the website for the Mail Handlers Benefit Plan, coventry network, to find an in-network physician. I went to see this family physician in October and all was covered. Now, 6 months later, I went back. I consulted the website before making the appointment to make sure he was still covered in-network. Coventry now says that despite this doctor being listed on their approved website, and despite having covered this doctor as in network previously, this doctor is not now, nor ever has been, in-network. They insist that you must call to confirm any information on the website, because it could be out-dated. I'm not sure what the point of having the website is if you can not actually count on the information being true.

I took my daughter to see a different physician listed on their website as in-network. They covered the doctor's visit as in-network, however the blood test they performed and assessed on-site, within their office, was not covered as in-network. Apparently, Coventry says the doctor is okay, but the labs performed and assessed within the same room we saw the doctor, is not in-network.

These people have given me nothing but trouble and it is expensive insurance!!! I suppose $700 per month isn't enough to buy us 3 simple doctor's visits per year for sinus infections.
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yoke on 05/09/2011:
When making an appointment I always verify with the office that they accept my insurance. I find the websites to be out of date half the time. Doctors drop out of plans and the plans do not update their sites.
Anonymous on 05/09/2011:
You want to make sure the dr is in network EACH TIME you make an appointment. The website is updated about once a month. As far as the labwork, MHBP's preferred lab is Quest to be paid 100%. Since the labwork was done in the office, the person who read the labwork must have been out of network. But that's the risk you take if you don't use the preferred lab
Anonymous on 05/09/2011:
I would like to add that the insurance company doesn't pick and choose what doctors are in their network. The dr decides that. They have to agree to the insurance company's contract. You can nominate a dr to become in network. Forms are available on You give that form to the dr and the whole prcocess takes a few months.
olie on 05/09/2011:
The best way to make sure that a doctor is covered is to make phone calls. Call the doctor's office. Call the insurance company. Websites, and wa-a-a-a-y back 4 or 5 years ago the nice booklet of covered doctors, are not updated as often as ANYONE would like. Not the patients. Not the doctor's offices. Not the insurance company.

Maybe my insurer is made up of angels, but when a lab or radiology provider wasn't covered, I'd call the insurer and say, "We didn't have a choice." The insurer said, "Oh, you're right. We'll pay that at in-network prices."

Anonymous on 05/09/2011:
I was thinking about this review some more and I have another thought. If the doctor had been in network before, than its possible that they put the wrong TIN (tax identification number) on the claim. I see that happen a lot when I look at claims. TIN's change sometimes and if they used an old one, it would flag the dr as out of network. I would call MHBP and have them check the TIN.
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They Should Be Ashamed
Posted by on
Rating: 1/51
I just finally canceled Mailhandlers health insurance, and then changed my health insurance. I tried repeatedly to advocate for my necessary medical needs, only to be blown off from the mailhandlers customer service. Two MHBP providers have turned me over to collection agencies. Mailhandlers refused an MRI on my ruptured disc and then refused to cover a routine mammogram. Both physicians involved told me this should have been covered. I sent in doctor notes, orders, etc, REPEATEDLY.

I am very unhappy and am now struggling to pay $750. to the collection agency. This is a crime.
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Laurella on 03/04/2013:
Did the dr use routine diagnosis codes on the mammogram? A mammogram becomes non routine if the dr codes it wrong, or if they find something, like a cyst. People always blame the insurance company for tests not being covered, when its the dr's fault for submitting the claim wrong.
leet60 on 03/05/2013:
I am not an advocate for the method used by health insurers to review coverage requests. I will say, that the key to getting coverage approved begins with the physician's office properly coding the request. This is a routine problem with coding errors being made. The insurer will do all it can to reduce the amount they are required to pay as their interest is in making a profit. If the physician requests the procedure under an incorrect code, as Laurella stated it is more likely to be denied.
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