Basic Health Insurance Question UPDATED

I know exactly what you're dealing with. I've had it for almost 20 years. Interestingly, our "parent company" has changed (Aetna, United, etc) but the managing company (XYZ) has remained the same. It gets confusing in physician selection.

Every time I'm making an appointment, even with the doctor I've seen for 10 years, I call the managing company (XYZ) to be sure she's still in network. For new doctors I check online, then doublecheck with the managing company.

Many claims are denied the first time because the offices or hospitals just put XYZ or Aetna, and not both. It's insane.

UHC is a national health insurance company, one of the largest in the country. They are likely acting as the backbone of the smaller insurance company you deal with. XYZ has branded your product (insurance) but the systems through which they process claims, etc. are probably UHC. In your car scenario, UHC is GM and XYZ is Chevy or Buick or GMC. Just like you would buy a Chevy from a Chevy dealer and have it serviced there, you deal with XYZ. But they are backed by UHC.

E.,

It would help if you had just used the real names.

The way that I understand your question - UHC is the parent company and your schnozzle fritz is one of its subsidiaries (like esurance is a sub of All State).

Think of it as an umbrella. UHC is the umbrella and schnozzle fritz is one of the stems.

I've made a living with health insurance for 25+ years. No XYZ insurance isn't the same as UnitedHealthCare. UHC buys local and regional insurance companies for their computer systems and/or networks all the time so most likely XYZ was purchased by UHC but its not the same thing as UHC. Different network of providers, different payment schedule.

Moving forward you may find that things change and your network evolves to include more providers as UHC grows the network in your area.

I am having the worst time thinking of the proper term, sort of like when someone asks you what that guys name is and you can solve world peace but not remember that name. If your company is self insured they contract with larger insurance companies to process their claims. Bah, stupid brain!! A lot of unions are like this. Otherwise you would have to pay out of pocket and send in a paper claim. This way you hand them a card and you are good to go. I have explained this badly, honestly my brain is not working at the moment.
____________________
Not that my brain is working any better, well a little better but still can't remember the term. Any major insurance carrier negotiates different contracts and sells them as different packages. Like locally I don't think there is such a thing as out of network for our plan, leave the area and there is. That is the plan we negotiated with Cigna and Cigna negotiates the contracts with the providers. They can have multiple contracts with the same provider.

An example, Coventry processes claims for Missouri medicaid. There are other carriers that process for them as well. So your card says Coventry but you are medicaid. We know it by the address and the plan information. So someone can say they take Coventry but they won't take medicaid. Clear as mud? United Healthcare is not your insurance provider they just process some or all the claims for your plan.

I am assuming that Federal employees are given more choices than your XYZ. My father is under Blue Cross Federal. Oddly that sucker covers darn near everything under the sun.

Sorry if I seem kind of out of it I was home most of last week with a child who had minor surgery. I just analyze data I don't actually put the data in there but I have a pretty good idea what the other departments do here, I work in a billing office for a group of doctors

sounds like XYZ got gobbled up by giant UHC. so XYZ is a smaller cog in the giant UHC's mechanism.
UHC not only gobbles and administers the smaller cogs, but operates as an actual health insurance company in its own right. so there are some providers that deal directly with UHC in that capacity, but not with its smaller cogs.
since your 'in' is with the smaller cog, you have to abide by its specific rules, not the bigger more general ones that apply to UHC.
khairete
S.

I will be curious to see other's answers. I don't know if mine is "right" but this is what I thought. Like you, I deal with my "primary" clinic or my insurance company if I have an issue. However, my clinic is "managed" by a giant corporation. So no, I can't go to any doctor in ABC Health Care Conglomerate - I can only go to XYZ clinic, which is the one I picked. In fact, ABC Health Care Conglomerate has clinics and doctors that do not even accept my insurance. I always figured that ABC Health Care Conglomerate buys up these smaller clinics and is kind of the manager - makes sure that folks are paying the bills and they are the ones setting the "contract price" that my insurance is going to pay for services to XYZ clinic.

Hmmmm . . . hope to find out the "real" answer as like I said, mine's probably way off :)

This sounds somewhat like ours. We had a "special" BCBS plan that his company had, but the parent company was Anthem. We did everything through "special" BCBS and had to use that network for better coverage and whatnot. It would not work if we tried to go through Anthem's network or any other BCBS network. We never dealt with Anthem. But, when there was a data breach, BCBS said don't look at us and gave us Anthem's information to deal with it.

UHC (UnitedHealthcare) is an insurance company. I'm not sure what XYZ is in your example - you have two insurance companies?