MINNETONKA, MINNESOTA -- I just read an article that says, “Hospital executives rank United Healthcare as the worst insurance company in the United States.” (It is available here: www.allbusiness.com/health-care/health-care-facilities). This will come as no surprise to many members and providers alike. Like many others, I want to share my recent experience with United Health Care so that people can decide for themselves whether or not this is the kind of health insurance they feel they want to purchase for their families.
I am a neuropsychologist and was asked to see a UHC member for neuropsychological testing. I filled out all of the appropriate forms required by United Healthcare and received a telephone call authorizing me to test their member. They gave me a cap on the hours (13 hours total) and an authorization number. I provided the services as promised and then sent the appropriate claim to the United Healthcare offices.
When they sent me the check, there was a note on the Explanation of Benefits saying I had agreed to a discounted fee (an approximately 50% discount, mind you) through an organization called MultiPlan (If you haven't heard of them, you're in for a treat. They contract with insurance companies to try to persuade clinicians to agree to a reduced fee and they get paid a percentage of what they "save" the insurance company.) Needless to say, I do not and never will have an agreement with this company, as I do not support business practices such as this.
When I contacted United Healthcare to straighten this out, they told me I had to deal with MultiPlan. Multiplan never answers their phone (I wonder why) so I got nowhere until I filed a complaint with the Better Business Bureau. This got the attention of **, a Consumer Affairs Advocate for UHC (1-800-842-2656). She researched this issue and came up with a fabulous solution!
She decided that United Healthcare had authorized this treatment in error and paid me in error AFTER I HAD RENDERED THE AUTHORIZED TREATMENT to their member. They then "recalculated" the claim form and decided that I actually owe THEM money! They have asked for the entire amount back ($966.68). They have a very fancy way of explaining their "logic" and have added that the original error was with their processor and they have arranged for her "to receive additional training or other intervention as appropriate."
With a second patient, they attempted to get me to accept a reduced fee through MultiPlan for another member and I declined. After that, they refused to pay me AT ALL for the services I provided to the other member while he was in the hospital. United Healthcare also authorized these services and the correct authorization number was submitted with the claims.
In both cases the services were requested by a physician and approved by United Healthcare. The services were rendered as authorized and the appropriate claims were filed. Unfortunately – and this really is the sad part – both of these claims will have to be paid in full by the members. These claims total thousands of dollars.
As I'm sure many of you know, United Healthcare is the focus of a Class Action Lawsuit in New York because of their questionable business practices. When I Googled “United Health Care reviews,” I was SHOCKED at the number of complaints against this company. How is it that they are getting away with this kind of behavior?
For as long as both Hubby and I have had full time jobs with benefits, we have almost always elected to use my husband's benefits for medical and dental insurance (mainly because I liked their medical insurance more than mine). We would reevaluate this every November when our respective employers' open enrollment period would begin. It's a system that has worked well for us as the coverage has almost always been comparable between our two workplaces.
Last November, when my job's open enrollment was announced, I asked my husband if he had heard anything from his job about OE. He hadn't so I held off on making any changes until close to the end of my enrollment period when I asked him again about it. He said that they had told him that they wouldn't have any information for a few more weeks but as far as he knew, there hadn't been any talk that year about changing providers (it had been a concern in past years as Blue Cross was trying to jack up the prices as usual).
Assuming that things were going to be status quo, I made no changes to my employee benefits aside from adding ** to my list of dependents for life insurance and vision insurance (I always carried the vision since his job didn't have any at the time). Two weeks after my job's OE period ended, my husband called me at work to tell me that his job was switching both the Medical and Dental benefits to UnitedHealthcare.
Since they had ** footed around and waited until the second week in December to make this announcement, we were SOL. Fortunately all of our physicians were in-network, so that didn't have to change. As far as dental insurance was concerned, I didn't really have any problem with whatever they offered since we had never used the dental benefits no matter who carried them. We just had it as a "just in case."
This spring, we found out that ** has cavities. A lot of them. And they're going to require a lot of work beyond the usual fillings (long story, not going into that). Anyway, we got an estimate from the dentist and I noticed that what was actually listed as the patient's responsibility (about $900 out of the nearly $5K total bill) was much less than what they had told me would be my portion (they told me over the phone that I would be responsible for about $3200 of this bill).
I looked at the benefits sheet for our dental insurance and I saw the line that said "Annual Benefit Maximum" was only $1000. I called UnitedHealthcare (their people are very polite, I'll give them that) and they confirmed that they will only pay about $1000 per year per person. What good is that when you're looking at work like this? It was bad enough that I had to search high and low for a pediatric dentist that was "in network" because the insurance would pay nothing for an out of network dentist, but now the most they'll pay is $1000?
I thought maybe this was par for the course for all dental insurances (they want prevention and early intervention rather than waiting until something like this happens, I'm sure), but then I looked over the benefits that my employer's dental insurance provided (MetLife), their annual max was $3000! There's plenty of blame to go around here. We shouldn't have waited so long to take ** to the dentist. But I blame my husband's job for waiting so long to let their workers know that their benefits would be changing (had we known that they were switching providers, I would have gotten on my insurance even before I knew the specifics).
I blame the HR lady for convincing my husband to take the lower dental insurance that pays nothing for out of network (I wanted the better paying one that would have paid almost same for out of network as in network) even though that wouldn't have helped the benefit max (same for both plans). And I blame UnitedHealthcare for giving us such useless dental insurance for almost the same cost as I would have paid for the better coverage through my employer!
IRVINE, CA, CALIFORNIA -- I CONTACTED OPTUMRX: MY MESSAGE TO THEM WAS THE FOLLOWING. Wondering why it is costing me more money to use mail order for my insulin than it would be if I ordered it from the local pharmacy? Local Pharmacy it cost $30 for one vial of 70/30 and through you folks it costs $41.66 for each vial! It would be cheaper for me to not get it from you folks. Is there anyway we can cancel or send order back?
Their answer was this: Thank you for your inquiry. Your order for Humalog Mix shipped out on 10/24/12 with an order number of **. The UPS tracking number is **. For safety reasons, once a medication leaves our facility we are unable to accept it back or refund any money. We apologize for any inconvenience this may cause. If you have any further questions, please reply to this message by clicking the reply.
NOTICE MY QUESTION WAS NOT ANSWERED JUST IGNORED. Many of us cannot just change health INS companies when they control so much! Many of us are on fixed incomes so we are at the mercy of these money grabbers! But one day what goes around will come around I just wish I will be there to see it happen to them!
ACCORDING TO UHC WEBSITE IT STATES THAT USING OPTUMRX IS AND WILL DO THE FOLLOWING: OptumRx is your best choice for a mail order pharmacy because you will be able to receive up to a three-month supply of your prescriptions, convenient home delivery and potential savings. (I ask where is the potential savings?)
I also notice that it states that standard shipping is used: Standard shipping is provided at no charge and there are no additional fees. (According to Optumrx they charge $75 for shipping my insulin. Where is the savings in that?) Please realize I just retired and before had UHC but they used Medco Pharmacy. I was only charged $120 for 5 vials of the same insulin for three months. So you see where I am getting screwed.
SALT LAKE CITY, UTAH -- My doctor requested an MRI authorization from United Healthcare. United Healthcare denied the procedure. BUT, they paid the vendor when they submitted their bill. When I called United Healthcare about the authorization and if I could pay for the procedure myself. I was told by 2 customer service reps that I could submit the bill and I would be compensated. NOT!!
After 2 months of discussion with various customer service reps (every time I called, I had to give all the particulars of the situation as they could not find the info in their system). Each call took about 60 minutes. At this point, I was told that United Healthcare did not make payments to members but had to pay the vendor. When I asked to speak to a supervisor on one of the calls, I had to ask 4 times and get nasty before they transferred me to a supervisor. I was told I could file a grievance and claim.
I received a letter from United Healthcare that they would "discuss" my displeasure with their customer service dept. LOTS GOOD THAT DID I AM SURE. I was told that even though United Healthcare paperwork said the grievance and claim process took 60 days. A customer service supervisor said it wasn't 60 days BUT 60 BUSINESS DAYS. Quite a difference. We have just asked United Healthcare how we would be compensated for emergency services out of country. I was told that I could submit a claim to United Healthcare and they would pay me.
REALLY - United Healthcare wouldn't compensate me for a procedure in the United States and I am to believe they would compensate me out of country??????? I would not recommend United Healthcare to anyone and plan to select another medical provider during the current enrollment period.
UHC is ridiculous. Does not stand for United HealthCare... more likely Unbelievable Hypocritical CRAP!!! I am a Breast Cancer survivor and had one type of reconstruction that did not work because of 3rd degree burns from radiation. I am in constant pain, for multiple reasons and there is easily discernible visual deformity... I contacted UHC to locate a DIEP surgeon (this is the only real option if basic expander to implant surgery doesn't work) - someone from their nurse line called me back saying they did not have a specialist after they contacted 15 in-network providers.
Then they told me to file for a Gap Exception for consult - which I did. I located Dr's who do this procedure and gave them all the information as I was instructed to do. They denied the exception for different reasons (let's revisit - same procedure - same need - just different doctors) 1 was denied because they tried to call me 3 times in one day and I did not get back to them that day... (BTW I had told them I would be out of town - and they advised me to call and check the status in 4-5 days) and then one was declined because they said they have in network Dr.'s.
The first name they tried to give me was the doctor that did my original FAILED surgery - so I quickly explained they were wrong he did not do the necessary procedure.. they then sent me a letter with 3 names so I contacted the Dr's they gave me and the staff at each office stated they do not do that type of surgery.
So I sent a letter detailing this to UHC and expressing my concern that whoever is making the decision does not understand the procedure and that not all breast reconstruction after cancer is successful especially when there is damage from radiation. I also sent along a Clinical Gap Exception request (which one of their reps told me is what I needed to do) from my Primary Care Physician.
Still they are ignoring me. I do not understand. I have done everything you have asked. Believe me - I would just have assumed/actually preferred not GETTING Stage 3 Breast Cancer at 43 years of age and needing 2 rounds of Chemotherapy - a double mastectomy - 2 additional surgeries and then daily radiation that caused 3rd degree burns... But it happened. Now it is time for UHC to do what they are supposed to do - provide care.
APPLE VALLEY, CALIFORNIA -- After being told that my mom who has Alzheimer's would have NO premiums (turned out to be a lie as we got a payment book shortly thereafter) and very low co-payments on her meds, etc., and being promised that this company provided much better hospitalization coverage, I agreed to switch my mom from her previous healthcare.
First off, they couldn't get the effective date correct. She signed the paperwork in January 09, and we were told it would be effective March 09. Then the sales representative called me back to say that was a mistake and it would be in effect February 09. Went to get RXs filled in Feb and was told she was still under her old plan, but the co-pays did not match what she had previously been paying. Spent over an hour on the phone with these people, who said her insurance wasn't in effect until March 09. OK, so paid the higher co-pays on her meds.
Waited until March 1 to get an RX filled for her dental appt, and was told it was not covered. Called back to Customer Service on Monday and was told that she was good to go for dentist and RXs (after being switched around the country and talking to at least 6 or 7 reps). My husband called from the dentist's office, livid, because they could not confirm her eligibility.
Oh, and on March 1 we were told that her eligibility was to EXPIRE with NEVERCARE on Feb 29, 09 - THERE WAS NO FEB 29, 09! And why would it expire if it is a new account that had never been in effect yet? My husband tried calling and was told that there were multiple computer screens that had different data in them. Also, they lost the power of attorney that we gave them when we applied for this coverage. Had to send it again - who knows if they have it this time or not.
Then, when I went to get another of her meds refilled, I was told that the co-pay was $122.77 - that for a medicine we had only been paying $3.20 on before. So basically, I am convinced that the sales representative knew absolutely nothing about what she was selling or else was just flat out misrepresenting her product. Either way it is inexcusable to treat seniors with limited incomes like this! I have now switched her to CAREMORE (as fast as I could) and am praying that goes smoother, but still have to live the rest of this month with NEVERCARE and am not sure if they will cover anything at all or not.
I am pretty sure they have NEVER paid a claim on ANYTHING for ANYONE before - that is how it sounds when I am trying to deal with this company. Thought Secure Horizons had a decent reputation, but I guess not this part of the company! Terrible! Terrible! Terrible! Oh, and I can't even e-mail customer service via the web site - no e-mail address is listed! They can rot in you-know-where before I pay any premiums on this garbage! Don't believe their lies!
NEW YORK -- Essentially, United Health Care is a fraud, starting with the bogus name they use on your membership card, "AARP Medicare Complete." They're not Medicare at all!! They are just "affiliated" with them so they can legally use their name, just as they do with AARP. It's all about marketing, NOT giving you great service. Their sales representative promised me that I would be able to use all my own physicians, which was a [bold face] LIE. You can only use those on their private list, and that's for only simple, cheap "health" procedures.
When I went to use them to cover a recent minor surgery, I was shocked to learn from my doctor that I had been turned down!! Why? Because when I had asked all of my current doctors if they would accept Medicare, they all agreed. One catch... none of them accepted United Health Care!!! Get it? they have nothing at all to do with "real" Medicare, only the right to use their name!!!
Here's how United Health Care rips you off.* One month before you turn 65, they FLOOD you with their advertising materials, all of which look "official." Then there fast talking phone reps make you believe that you're getting a "good deal." You THINK that you're being covered by Medicare, but you AREN'T. The additional fact that they also use the "AARP" logo in their ads gives you even more reason to believe that they're a "good deal," when the only thing they're good for are basic, cheap office visits.
Should you need even minor surgery like I did, if you doc isn't on their extremely limited list, your shit out of luck. The fact of the matter is, the phone representative totally lied to me when I asked him if I could use my own doctor. You can't. Thankfully, however, in two more months I'll be able to cancel my membership with this clip joint and sign-up with the only one I should have in the first place... original Medicare.
My prescription required pre authorization for the new year. My doctor's office was very quick to react with appropriate documentation. Unfortunately United Healthcare was very incompetent. Making multiple calls (more than 4) and being put on hold for an average of at least 12 minutes per call I finally asked the person ** to pull up the pre-authorization approval and verify that it was correctly submitted. It was then determined that United Healthcare had completely messed it up. They had corrected the verbiage of the message but had "forgot" to change the unit of measure.
I was then told to call back in 2 hours because the department that handled pre-authorizations was not open. It was I, as a consumer, asked that they open the pre-authorization to verify that it it was correctly filled out before one of the 5 representatives I talked to finally opened the document and discovered that my script had not been filled in 4 days due to their own incompetence.
My career has been in analysis and problem resolution and the most basic, first step process is to review the document that is causing the problem. Yet, none of the representatives even though about doing this until I, the customer, recommended that they do this. Even after they finally see what they messed up it will take 3 hours for them to correct it. Sadly, before I made the request for them to open the pre-authorization form all of the representatives were submitting a request for review which would have taken anywhere from 2 to 7 days.
I have already been without the prescribed medication for 4 days. I was looking at potentially another 7 days without medication. It is fortunate that this was not a life threatening medication and in need of quick resolution by such an inept company. I am appalled at such ineptness and disgusted with this service. I now have to drive in an ice storm to pick up a script that is 4 days late due to the incompetence of this company.
MARQUETTE, MICHIGAN -- I retired in December 2011. After retiring, I had to pick up my own insurance for my wife, son, and myself. Our premium was $560 per month with a high deductible of $2500. This insurance did not cover anything. I had hand surgery. The doc schedules me for trigger finger surgery.
Two weeks later, I have surgery. I then need therapy on the hand. The therapy was $3000. 3 months after hand surgery, I get a bill from the hospital saying United not covering surgery. I get a $2000 bill. A simple hand surgery cost me $5000 out of pocket plus my premium. I blame the hospital also for getting authorization for surgery, but not checking to see how much the insurance was covering. Only $500 was covered.
My son had a shoulder injury. United covered the MRI, but I got stuck with another $3000 in therapy for my son. My wife had a bunch of women's testing. We get a bill showing United is covering $9.00, yep, $9.00 out of a $150 charge for a test. I figured I spent about $6000 in premiums, and about another $10,000 in out of pocket money for things not covered. From what I guess, only about 5% of everything was covered.
I am getting a new insurance plan. This plan really sucks. You could do better putting your premiums in the bank and paying cash for medical cost. Thank God nothing serious happened to any body in my family while we had this insurance. Golden Rule should be called Golden Shower. I plan on researching to the penny what I paid and what United Health Care did not pay. It is amazing. Do not use United Health Care Golden Rule. **
TRUMBULL, CONNECTICUT -- One star is way more than they deserve. I pay a fortune for the worst health insurance I've ever had. In order to avoid a $1,000 deductible, I have to get my x-rays and lab work done at facilities other than a hospital. I called United Healthcare to find out where I could get blood work and an x-ray done without incurring the deductible. Turns out there ARE no places where I can get both done, which is an outrage in itself.
So, I went to 2 different places, 20 minutes apart. A couple of weeks later I got a bill for the X-ray! They told me where to go, then they charged me for it. It was in-network, on their list of approved facilities, and they sent me there, but I still had to pay for it. Great work, United Healthcare!! You're really on the ball there.