FAQ

I have unpaid bills that Universal HMO of Texas, Inc. has not paid. How do I file these claims?

To make a claim for any amount that is owed by Universal, you must file a proof of claim (POC) by the claim filing deadline of June 30, 2014. The POC is available for download on this site in the Notices section. Directions for completing and submitting the POC is included with the form.

Do I have to file a claim if I have already filed my claims with Universal HMO of Texas?

Yes. Because of the problems with the Universal HMO of Texas claims processing system, all people seeking payment for outstanding claims should submit their outstanding claims to the SDR address indicated in the “Contact Us” section of this web site.

How can I get a POC for filing my claims?

This web site has a POC form which can be printed and used to submit your outstanding claims. Please refer to the Notices section of this web site. Directions for completing and submitting the POC will be included with the form.

What happens after I submit my Claim and bills?

Claims will be accepted by the Texas SDR, Jean Johnson, and will be processed then paid
(according to Medicare guidelines and subject to Court Order). After Claims are submitted, they
will be reviewed for coverage, and, if appropriate, paid according to policy guidelines and orders
of the court. On February 12, 2015 the District Court of Travis County, Texas granted approval
of the SDR’s application for alternative claim adjudication procedures. With this approval in
place the claim review process has begun. Proof of Claims received no later than 11:59 PM
Central Standard Time before the claim filing deadline of 6/30/2014 will be reviewed as a
priority according to Texas Insurance Code Chapter 443. The Special Deputy Receiver and her
staff realize the hardship resulting from this Liquidation of Universal HMO of Texas, and are
doing everything possible to maximize asset recovery in order to make distributions as quickly as
possible.

Can Providers seek payment from former members for debt owed by Universal HMO of Texas for medical services?

No. The Order of Liquidation, filed May 17, 2013, states in section 4.10 the following:

Injunction against Health Service Providers

4.10 To any and all physicians and other health service providers under contract with or providing services to Universal HMO of Texas, Inc.:

Each of you are hereby restrained and enjoined from:

(a) Charging, billing, demanding or collecting payment from members, enrollees or beneficiaries of Universal HMO of Texas, Inc. in violation of any applicable statutory or contractual provisions; and

(b) Interfering with these proceedings or the Receiver or her designees.

Click here to view the Order of Liquidation

Also:

In Network Provider Contracts state:

3.6 Member Held Harmless. Provider hereby agrees that in no event, including, but not limited to, nonpayment by Health Plan, insolvency of Health Plan, or breach of this Agreement, shall Provider bill, charge, collect a deposit from, seek compensation, remuneration, or reimbursement from, or have any recourse against Members or persons other than Health Plan, Provider or persons acting on Member’s behalf for Covered Services provided pursuant to this Agreement.

This Section 3.6 shall not prohibit collection of supplemental charges or Copayment, Coinsurance and Deductibles made in accordance with the terms of the applicable Benefit Program or fees for non-Covered Medical Services delivered on a fee-for-service basis to a Member. Provider further agrees that (i) this Section 3.6 shall survive the termination of this Agreement regardless of the cause giving rise to termination and shall be construed to be for the benefit of Members; and (ii) this Section 3.6 supersedes any oral or written contrary agreement now existing or hereafter entered into between Provider and Members or persons acting on their behalf.

Where can I get copies of approved court orders relating to the Universal HMO of Texas, Inc. in Liquidation?

This web site has copies of the various approved orders relating to the Universal HMO of Texas, Inc. in Liquidation. New orders will be posted as they are received.

I wish to obtain a copy of the certificate of service for the receivership case, so that I (or my attorney) can file a legal pleading in the receivership. Who do I contact to obtain a copy?

Michael C. Roth, Wisener Nunnally Roth, LLP, 245 Cedar Sage, Suite 240, Garland, Texas 75040 Phone: (972) 530-2200, Facsimile: (972) 530-7200.