UHC’s HSA policy language

My post about a colleague’s unwitting effort to educate the rest of us about the nuances of HSAs and payment policies has drawn a bit of interest amongst loyal readers and a couple of others as well. That requires follow up.
The plan itself is not a full service plan, instead it is a “hospital surgical” plan that covers (among other things) emergency room services but only in a hospital, and does not cover physician office visits. A brochure, entitled “UHC Choice Plus network” was included in the marketing package, and states that “when you use a network provider for medical services you benefit from the special rates offered to covered members…” that my colleague interpreted, reasonably, to mean that s/he would benefit from UHC’s negotiated discounts. And, when the colleague’s dependent needed emergent care, located a UHC-contracted provider, and went to that provider.
Here’s a quote from the colleague:
“it would be really hard to negotiate with a facility given the fact that I was not aware that I needed to as well as that I was attending to an injured child. Actually my spouse was as I was traveling on business. The furthest thing from my spouse’s mind at the time was negotiation of rates. This is why we contracted with UHC…”
Golden Rule is the United Healthcare entity responsible for most of the company’s HSA offerings. Their website has a disclaimer regarding care, quality, medical services, but nowhere is it mentioned that payment for services under a deductible are not subject to the network rate. Here’s what the language says (bolded text is my edit):
“UnitedHealthcare arranges for providers of health services to participate in a network made available to you as a Golden Rule Insurance Company insured. Network health care providers are independent contractors and are not employees of Golden Rule Insurance Company or UnitedHealthcare. Golden Rule Insurance Company makes payment to network providers through various types of contractual arrangements.”
Another part of their website references the “shared savings” program; here’s the language: “When you seek health care in the UnitedHealthcare network, you can take advantage of network benefit levels and negotiated discounts with network providers. Staying in-network will result in the lowest out-of-pocket cost to you.” Seems pretty unambiguous…
But, the site then directs you to go to another site (Multi-Plan), to find providers who participate in the “shared savings program.”
So, technically UHC is more correct than not; the colleague is likely not a “covered member” for that particular service and therefore the health care sought and received is not covered, and therefore not subject to the UHC contracted rates.
But, and this is a mighty big but, UHC’s stance fails, miserably, what my friend Peter Rousmaniere refers to as the “reasonableness” standard. What would a reasonable insurance customer making a reasonable interpretation of the language conclude?”