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Optum United Behavioral Health Responds to NASW Letter

Mirean Coleman, LICSW, CT
Director of Clinical Practice

April 2024

In February 2024, NASW members informed the association of mass overpayment requests from Optum United Behavioral Health. Optum Recovery Service reported that they paid clinical social work providers 100 percent of the psychologist rate when they should have been paid only 75 percent of the psychologist rate. As a result, Optum requested overpayment of 25 percent from clinical social work providers who received reimbursement for services provided to beneficiaries of Medicare Advantage Plans.

In March 2024, NASW CEO, Dr. Anthony Estreet, responded to Optum by email and requested the opportunity to meet with them about their overpayment recovery efforts and possible measures to take to mitigate. A copy of the letter is available for review at https://www.socialworkers.org/Practice/Tips-and-Tools-for-Social-Workers/Optum-United-Behavioral-Health-Overpayments

The leadership of Optum responded quickly to NASW’s letter. As a result, two meetings were held in March 2024 and NASW successfully advocated for the following:

  • the appeal of overpayment requests was expanded from 30 to 90 days.
  • repayment of overpayment requests was expanded from 6 months to 12 months. There is no interest on repayment nor are there loans for repayment. Installment plans are acceptable.
  • in-network Optum providers who received overpayment requests due to the payment error should submit a dispute letter to Optum for waiver or forgiveness. Out of network providers do not qualify and must adhere to the overpayment requests. By law, Optum is required to collect the overpayment requests involving Medicare dollars.
  • contact information will be provided on future overpayment requests.
  • Optum will inform NASW and clinical social work providers in advance about overpayment requests, and as a result, has prepared the following document Medicare Advantage Reimbursement Fact Sheet (providerexpress.com)

Although NASW was unable to change the collection of overpayment requests for the payment error made by Optum to out of network providers, NASW will continue to meet with Optum regularly to troubleshoot concerns expressed by members. Questions from members about Optum’s overpayment requests can be sent to Clinical.Practice@socialworkers.org