These modules are awesome.
I’ve always loved the puzzle genre of video games. Starting with the Infocomm text adventures of the early 80’s through Myst and similar adventure games in the 90’s to recent classics like Portal, The Talos Principle, and The Witness, I’ve spent thousands of hours of gameplay in this genre.
The United Healthcare Medical Reimbursement Form, though, is in a class by itself. Unlike those other games that transport you to a different world – often a fantastic world where writing words turns into a linking book you can literally jump into, or solving puzzles awakens you to an empty world ready to be repopulated with the brightest minds that survived an apocalypse – the United Healthcare Medical Reimbursement Form takes a more dystopian view. If you don’t fill out the form properly, you won’t be reimbursed for your medical expenses, you’ll go bankrupt, and whatever ailment you were trying to get reimbursed for will likely kill you or at least permanently disable you. If you do succeed, your life returns to normal. No super powers. No fantastical linking books. No rebuilding society. You just don’t immediately die.
And if that wasn’t enough, the gameplay is the same brutal style you may remember from those Ken and Roberta Williams point-and-click adventures where one wrong move early on can keep you from progressing at a later stage. It can be devastating and very time consuming!
So let’s get to it. You recently went to a doctor who refuses to accept insurance because they can’t afford the staff necessary to jump through the hoops you’re about to jump through. What makes this game so realistic is that you have to supply your own form from an actual doctor that you see!
You start by logging into myuhc.com using your HealthSafe™ account at https://myuhc.com/ with your preferred browser on any computer or smart phone. (A HealthSafe™ ID is similar to an Xbox GamePass, or similar ID on other gaming systems.) I was playing on macOS, so I chose Safari. (Note: We will return to this important point later!) When you do, you’ll be greeted with a series of progress bars that don’t seem to be doing anything specific. One fills up, then another one starts immediately. You can see hundreds of addresses flash by in an instant in your browser’s URL bar. I think this was a shout out to the long loading time of games past played on Commodore 64s, Apple IIs, and Atari 400/800s. But pay no mind, once the page finally loads, it will be full of information you don’t understand. Your first job is to figure out where to click to submit a claim. Fail that test and it’s game over for you.
There is a button labeled “Claims and Accounts,” but of course, it’s not that easy. (If you’re on mobile, you’ll need to access “Claims and Accounts” from the “hamburger” menu.) When you click it, it not only opens a horizontal menu below your choice, but also loads a new page with lots more confusing information on it! Next, you have to click “Submit a Claim.” Once you click on that, there are 4 additional options and you need to choose the right one or you’ll end up on the wrong form submitting incorrect information. (What happens if you submit the wrong info? I didn’t have the guts to find out!) In my case, this was a normal medical visit my spouse had with a neurologist, so I chose “Medical Claims.” Note that if you saw a mental health professional, that’s not technically a “medical” visit according to United Healthcare lore. You need to choose the option specifically for mental health in that case. I don’t recall why they separate them out, but I’m sure some astute reader can point out the event in the mythology of their universe that caused this schism we don’t have in the real world.
Submitting a Claim
Choosing the above option was confusing enough on its own, but what happens next makes basically no sense. Remember earlier when I said I was using Safari? Well, it turns out that each browser has a different response to choosing a claim form. I’ll discuss what happens in other browsers in a later section. When I clicked on “Medical Claims,” Safari opened a new tab, but showed no page. The address looked like the same address as the page I came from and it was selected. (I switched back and forth between the tabs to see if I was missing some clue that would explain why the page wasn’t loading.) After about 10 seconds of doing nothing and giving no feedback, it suddenly loaded. And sure enough, it loaded the page I had just come from. That’s odd, I thought. I know I clicked on “Medical Claims”. I was about to click on it again when it suddenly sprung into action and loaded the medical claims page! I had done it correctly! I just hadn’t waited long enough. I’m sure there was some sort of riddle or clue on the preceding page that would make this make sense, but I did not get it. Luckily, I figured it out by coincidence.
At this point you’re presented with instructions for what to do next. If the claim is related to COVID-19, you’ve got the wrong form and you need to go back to the previous page. (And here’s where it’s dastardly! You’ll notice the back button doesn’t work. Remember this opened the page in a new tab. Those game designers sure do make things tough!) In any event, this is the right form for my case, so I clicked on the “Start New Claim” button.
Next I’m presented with a form asking for my email address so they can send me a secure code to submit my claim. It may seem odd to do this. First, they have my email address, so entering one just seems like it reduces security. If someone got into my account, they could use their own email address and I wouldn’t even know they had submitted a claim from my insurance account. Second, do people regularly break into other people’s accounts, submit bogus claims forms with that person’s contact info on them, and let that person get reimbursed for it? That seems like an odd thing to do. But then, I’m not a game designer. Maybe there’s a scenario there I’m not understanding?
Anyway, once I get the code sent to my insecure email that anyone at my ISP can read, I’m presented with another form to enter my insurance member ID, group ID and date of birth. But wait. Aren’t I on the insurance company’s web site? Aren’t I logged in? Shouldn’t it already have that information to fill out the form for me? (Or better yet, not even show me the form!) It should! But I guess if they solve all the puzzles for you, it would take away the fun. It wouldn’t be much of a puzzle, would it? (If your browser accepts cookies, it will be filled out the next time you return, so I guess that’s good. I wonder if that means it’s stored in plaintext somewhere on my computer and I can edit it to send claims about other people? Probably not. I didn’t have time to find out.)
Who, What, Where, When and Why?
Next you’re prompted for whether this claim is for you or a dependent. I select dependent since it’s about my spouse. Now you probably thought that you had already chosen the type of claim back on the “Medical Claims” page. But they now ask you again about what type it is and even have entries for “Prescription Claim” (which if you recall was a different form on the previous page) and “COVID-19” (also a different form) as well as “Wig”. (I may chose that one next time! I’ve always wondered how I would look with a different hair style that I’m too afraid to actually try, knowing that it will take weeks or months to grow back if I don’t like it.) The choice you want is “Medical Claim (All other reimbursement types)”.
It was very clever of them to make the most common answer be right in the middle of the list surrounded by options that aren’t valid options! That should cut down on brute force solving of the puzzle.
Next they ask if the service occurred in a different country. After answering “No”, they want to know where the services were rendered. In my spouse’s case, it was via telehealth. One wonders why it makes a difference? If I received the same service over the phone or in the office, shouldn’t I be reimbursed the same amount?
Because this was for my spouse’s visit, I had to enter her information. Were this a real form in the real world and not a dystopian adventure, they would have had a drop-down with all my dependents listed so I could just pick one. (After all, they know all of them already since I have insurance for them.) But I let my willing suspension of disbelief remain intact despite the obvious plot hole. After entering her name, they helpfully CAPITALIZE it for me. For her date of birth, I enter just the digits without slashes, and it fills in the slashes for me! This is so realistic!
Once filled out and submitted, they ask 2 additional questions: 1) is this claim for an automobile or work accident, and 2) do you have other insurance? These are basically side quests, and I wanted to get to the meat of the game. I selected “no” for both. This is where the developers are playing the long game, though. They actually call me every 6 months and ask whether I have another insurance provider. If my answers don’t match, I imagine the game changes substantially! But as I said, I wanted to get right down to it!
Remember at the start of this I mentioned that you need to have a real bill from a real doctor? This is where it comes in. This is sometimes called a “superbill”. I’m not sure where the name comes from. Maybe because it’s super confusing? Super scary (since it controls whether you get your money back or not)? Or super unlikely to be accepted? I don’t know, but it’s a fun name.
For most of the rest of the game you are asked to copy data from the form your doctor gave you into the form in your web browser. Obviously, this game is a period piece so you have to do it manually. I think that’s pretty realistic for the period they’re trying to emulate. Nowadays, they would, of course, automate scanning the superbill using Optical Character Recognition to pull the information out for you and just have you check it over before clicking submit. Even my cell phone can do that!
But they don’t just have you copy the information since that wouldn’t be very fun or helpful. Instead, they’ve come up with a different name for each part of the bill and you first have to translate the name they used into the one used by your doctor (and most of the rest of the world). It starts with something they call a “TIN”. They call it a “Tax Identifier Number”. That’s not it’s name in the real world. It’s actually called an FEIN or just an EIN – a Federal Employer Identification Number. It’s like a Social Security number for a person, but for a business. And remember how when I entered my spouse’s birthday, it helpfully filled in the extra slashes between the day, month, and year? Well here you have to remember not to enter the dashes that are part of the FEIN because the form will not accept the number if you leave them in!
Next, they ask for the National Provider Identifier (or NPI). Here they use the correct terminology, sort of. It turns out there are 2 types of NPI in the real world. There’s the Provider NPI (yeah, it’s a little redundant) and a Billing NPI. They don’t say which one they want! You can try clicking on the “?” symbol to get some help, but it really doesn’t help much. They say they want your “provider’s” NPI, so that’s what I used and it seemed to work. I’m not sure how it differs from the billing NPI because as I mentioned before I’m not steeped in the UHC mythology very well.
Now comes the toughest part. Remember how I compared this game to some of the adventure games from the 90s where decisions made early on affected your possible paths later? You’re about to hear more about that!
For the next part of the quest you need to figure out wether you’ve been working with an individual provider or a provider group. It may not be obvious. Let’s say you see Dr. Mahmoud. You’d think that would be an individual provider. But if the name of the superbill is The Mahmoud Group, or Mahmoud Health Management, or just Mahmoud Inc., it’s probably a provider group. It may be hard to tell, and as with past decisions, entering the wrong thing can change how the game responds. In my case, I think it’s a provider group, so I start there.
Next I enter the group’s name and their zip code and press “Search”. It’s entirely unclear what you’re “searching” for. You just told them the name of the provider or provider group and the zip code. In any event, nothing happens when pressing the “search” button. The page just sits there. No progress bar, no loading. I figured this was another one of those long waits like I had back at the beginning, but nope. It’s just dead in the water. It turns out you can’t fill out this form in Safari! It simply doesn’t do anything in Safari, and you need to use a different browser. But wait! DON’T CLOSE THE SAFARI WINDOW!!! YOU STILL NEED IT!!!! This is one of the most dastardly game mechanisms I have ever encountered.
If you have another browser like Mozilla Firefox installed, run it. I did and of course it tried to get me to update like it does every god damned time I run it. But I’m in the middle of something, and I’ve heard the new version has ads, so ick! I just ran with what I had.
I went back to square one. I signed in with my game ID… er HealthSafe™ ID. I clicked through the “Claims & Accounts,” then clicked on “Submit a Claim” and attempted to click on the “Medial Claims” button. But this time instead of loading the page I needed in a new tab, it opened a new window with nothing but an obscure error message! (Something about 504 – Bad Gateway. Reminds me of the time I missed the Sphinx’s riddle and couldn’t get through the temporal gateway to finish my adventure!)
That’s right! You can’t complete this form with Mozilla Firefox, either! And this is where it gets interesting! I suddenly realized that I still had my Safari window opened. I went back to Safari and went to my account’s main page. I clicked on “Claims & Account,” then clicked on “Submit a Claim” and finally, clicked on the big “Medical Claims” button. When it opened the new tab, I copied the URL from there and pasted it into Firefox! Success! I don’t know if this is a cheat and I wasn’t supposed to be able to complete the quest in Firefox either, or if this is really the only way to solve the puzzle? Either way, it worked for me. But it didn’t get any easier!
Do It All Over Again
As you can imagine, I was back at the beginning and had to do the “security” dance. After getting my code, I reentered my member ID, group ID, and birthday. I reentered my spouse’s name and birthday. I reentered the TIN… er FEIN and provider NPI. And eventually I got to the search form and entered my doctor’s practice name and zip code and hit search…
Success! I was apparently searching for my provider in their database, or something. It would have been nice if the button had been labeled “Search for Provider” or “Provider Search”.
I could tell I was nearing the endgame at this point. I pulled out the magic scroll given to me by my doctor. It contained a number of bizarre incantations, but the form on the web site seemed to know about all of them. First, there’s a list of diagnostic codes. There’s one for every single ailment you discussed with your doctor. As you can imagine, they are random strings of letters and digits separated by periods. So I knew this was going to be a tough battle, but I was sure I could win it.
I entered the first diagnostic code of the form, A12.34, and pressed the white and blue “+ Add a Diagnosis Code” button. Bzzzt! The website chastened me for not putting it into the form correctly. You must enter only letters and numbers. No periods allowed, even though all of the codes have them. Clearly this beast is different from the one that demanded our birthdays earlier and happily added the slashes in for us. Here, it will not remove extraneous glyphs! I removed the offending period and pressed the “+ Add a Diagnosis Code” button again. It spent some time thinking then put a green bar next to the text input field, apparently indicating that I had completed that challenge successfully.
But there are 11 more codes to enter, and only the 1 field! How do I enter more? There is some text, not below the diagnosis code field, but below another question that’s below the diagnosis field, so you don’t know that it’s related. It says you can enter up to 19 codes. But there’s only a single field. Why? As I sat there staring at the field and the now grayed out “+ Add a Diagnosis Code” button I thought as hard as I could. As I moved my mouse around the page, hoping for an invisible button to appear, the “+ Add a Diagnosis Code” button suddenly turned blue and white again! Unlike a normal button that you’d see on a real web page, this magical button serves 2 different purposes depending on what you’ve recently done. If you haven’t entered a code yet, the button allows you to submit a new code. Once you’ve gotten verification that the code was submitted, pressing the button again adds a new field that allows you to enter another code. So it was hidden – just in plain sight!
I enter 11 more codes, pressing the “+ Add a Diagnosis Code” button two times after each field. Next I answer the question that stood between the diagnosis code text entry and the explanatory text about the diagnosis codes: “Is this request for services rendered by the same provider, for the same patient, on the same date of service? Please submit one claim form per patient” That’s a fair question, and I’m sure they get some devious players who try to sneak through different services for different patients! But this was not the case for me.
Next it was on to the “Procedure Code” also known as a “CPT code” or “HCPCS code”. This is a 5 digit code with numbers and possibly letters. I found it on my doctor’s provided scroll and entered it. It was “99215: OFFICE O/P EST HI 40-54 MIN” That sounds right. We did talk to the doctor for 40-54 minutes. Next it asks for the “quantity”. I believe we only had 1 quantity of 40-54 minute talks with the doctor, even though that is a bizarre thing to ask for. But it seems to accept my answer.
I then enter the start and end dates of the service. While I can imagine that service provided from, say, 11:30PM to 12:15AM could span multiple days, in this case it did not. My doctor’s office is not open at those hours.
Finally, I enter the “Total Service Line Charge Amount” of $450.00. But there’s another field named, ”Total charge amount.” I’m not sure how that is different from “Total Service Line Charge Amount”. So I just enter $450.00. Or I attempt to, when the beast fills it in for me!
Whatever! I press the “Next” button prepared to slay another beast. This is the final form, and it just asks me to upload the scroll my doctor gave me to start this quest. It contains all the information I just entered into the form (but you know, in a way easier-to-read-and-understand format).
I press the submit button and am told that they will think about it and get back to me to let me know whether I’ve won $450.00 or not in 1 to 3 weeks. I eagerly await my potential prize. I hope I am not disappointed.
UPDATE: About 3 weeks later I received a notice that I had won ~$215.00! Not bad for a first try. I’m sure there are some puzzles that I probably missed on the side quests that would boost my final score. We’ll see next month when my spouse returns to this doctor for further treatment!
Overall, this game was quite a challenge! As mentioned, this game does sometimes push the limits of believability. I mean, a form that can add or remove slashes, but can’t remove periods? It doesn’t even make sense. But if you can overlook that, you can start to appreciate the brain teasers it presents.
I was fortunate that I played the game using my spouse’s documents. Had I actually been sick or disabled and tried to go through this process with my own forms, it would have been a different story. And that leads me to another point. We need to support gamers who have disabilities. This game didn’t. Can you imagine having cognitive disfunction and trying to enter all this information? And fighting with 2 different browsers to get through it all? Imagine if you were sick and vomiting and had to fill out this form. Or even taking care of a sick kid. The gaming world needs to start dealing with people that have different abilities and this game failed miserably in that aspect. Hopefully they’ll release an update in the future that fixes the problem and makes most of the forms obsolete, but I won’t hold my breath.
The game does have replayability, though. Every time my spouse goes to see this doctor, we get to slay this particular dragon again. I think it will go faster now that I know some of the secrets! That is, assuming they don’t update it to make it even harder!
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