Payment of benefits
When you assign your benefits under the Plan to an out-of-network provider with UnitedHealthcare's consent, and the out-of-network provider submits a claim for payment, you and the out-of-network provider represent and warrant that the covered health services were actually provided and were medically appropriate.
To be recognized as a valid assignment of benefits under the Plan, the assignment must reflect the covered person's agreement that the out-of-network provider will be entitled to all their rights under the Plan and applicable state and federal laws, including legally required notices and procedural reviews concerning their benefits, and that the covered person will no longer be entitled to those rights. If an assignment form does not comply with this requirement, but directs that your benefit payment should be made directly to the provider, UnitedHealthcare may in its discretion make payment of the benefits directly to the provider for your convenience, but will treat you, rather than the provider, as the beneficiary of your claim. If benefits are assigned or payment to an out-of-network provider is made, the Plan reserves the right to offset benefits to be paid to the provider by any amounts that the provider owes the Plan as described in "Overpayment and underpayment of benefits."
UnitedHealthcare will pay Benefits to you unless:
- The provider submits a claim form to UnitedHealthcare that you have provided signed authorization to assign benefits directly to that provider.
- You make a written request for the out-of-network provider to be paid directly at the time you submit your claim.
UnitedHealthcare will only pay benefits to you or, with written authorization by you, your provider, and not to a third party, even if your provider purports to have assigned benefits to that third party.
Payment of benefits under the Plan shall be in cash or cash equivalents, or in the form of other consideration that UnitedHealthcare in its discretion determines to be adequate.