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United Healthcare's Questionable Business Practices
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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 Cindy Hernandez, 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?
     
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Venice09 on 2010-07-01:
I live in New York and when my father became ill, UHC paid for everything, no questions asked. It really helped reduce the stress for my father and myself, as we were already dealing with a lot. That was around ten years ago. I guess things have changed drastically since then. Your experiences with UHC are indeed very sad for you and your patients.
LenaSunShine on 2010-09-12:
We used to have UHC in AZ where legislators passed a law limiting the amount of time insurance companies could take to reimburse medical providers. We were continually squeezed between UHC and our medical providers, which isn't good medicine! After the law was passed, suddenly payments were going through more smoothly (all states should pass such laws). UHC was slapped with a fine in AZ too. Then we managed to escape them, but now we are stuck with them again via one of their subsidiaries contracted to process our employer self-funded insurance plan. We are again experiencing slow payments.

I noticed when the changes for all insurance companies started, about 8 years ago, and they've only become more predatory and worse about ripping off their members. Now, even employer provided plans exploit us and steal from us, as they seduce employers into signing on to more third-party services, marketed as a gift to employees, oh so helpful, all of which make a profit at our and our employers' expense.
LenaSunShine on 2010-09-12:
There are two reasons insurance companies have been and are getting away with robbing us and helping to tank our economy in the process: legislators and medical providers let them go unchecked until they became so rich and powerful, creating an entire industry of third-party industries just to pass our money from us to our medical providers, that it is now much more difficult to stop them. Physicians always had more political clout than did consumers and should have refused the invasions of our medical privacy and all that fine print and arm twisting as soon it started, protecting both patients and providers, but they didn't. As long as they were getting paid, they let the insurance companies create misery for patients and didn't start protesting until it became untenable for them too. Legislators bowing to moneyed lobbying interests did not protect us, which is why medical professionals should have banded together and fought back through their own political pressure. It still needs to be done, it is just much harder now than it would have been if it had been nipped in the bud, and many have suffered in the meantime.
Skye on 2010-09-12:
That is so not true. There are actually doctors out there, who went to school to help others. It's not always about the money for them. In fact, I know two doctors who have gone into private practice, and refuse to deal with insurance any longer. They are sick and tired of insurance companies telling them what they can, and what they cannot do. A person sitting behind a desk is in no position to evaluate someone's medical needs.
Anonymous on 2010-09-12:
I have to agree with Goduke some doctors Charge you a fortune for a simple procedure and you can't negotiate a lower price with them as what happened when I had my teeth worked on 5 grand for a couple new fillings and a cleaning highway robbery.
Anonymous on 2010-09-12:
The doctors also have contracted rates with the insurance companies. The insurance company pays much less than what the doctor may charge someone for the service that is paying cash. That's why so many doctors are not accepting medicare patients anymore. So, if your insurance company won't pay for a service, then you can still have the option of paying cash and most doctors will give you a discount for that (of at least 20%).
Skye on 2010-09-12:
Wally, if you are paying $5000.00 for 2 fillings and a cleaning, I think you better find a new dentist.
Anonymous on 2010-09-12:
Man, wally, that is highway robbery. As Skye said, find a new dentist. Angie's List has even added a physician's/dentist list. That is a good place to start if you don't know anyone who can recommend one.
Anonymous on 2010-09-12:
lol I know sky, I'm looking around cause those fillings fell out need someone who won't charge me an arm and a leg this time.

LenaSunShine on 2010-09-12:
@Skye; You missed my point. I did not refer to individual doctors or why they went into medicine. I referred to the bigger picture of physicians and other medical care providers as a profession. It is their profession and they did and do have more clout than the general public to stand up to insurance companies by organizing to protect both their professions and their patients' rights.

Our medical privacy is Completely gone now, with untold numbers of people with access to it that you and I do not even know exist, and with all of us answering to insurance companies about what medical treatment we can receive. It wasn't like that 15 years ago, but after physicians sided with insurance companies in the 1990s to blow the Clintons' efforts at healthcare reform out of the water, insurance companies took it as a green light for an all out assault in the name of greed. What we have now is the result. Physicians allowed that to happen instead of raising hell when insurance companies first started making moves to come between patients and their medical providers.

As for providers not accepting insurance, I live where many providers refuse to belong to any networks and some refuse to deal with insurance companies at all because there so few of them they don't have to, but that means only those of us with the cash can receive their services. In a system that has become dependent on insurance companies and their feeder industries, not accepting insurance leaves many out completely.

You're absolutely correct about insurance companies inappropriately telling physicians what they can do. My point is, just who has the power to change the status quo we've descended to? The medical providers, that's who, if they will organize and do it. If they did, that would be practicing good medicine because living with the daily stress and fear of illness and injury and fighting ruthless bureaucracies makes Americans physically sick. We need our medical professionals to join together and take medicine back to protect all of us.
Skye on 2010-09-12:
I did not miss your point. I was making a point about certain doctors I know, that are sick and tired of insurance companies, just like everyone else is sick of them. There is no such thing as medical privacy, and I know how the system works. HIPPA, ha joke, and just about every state now has prescription monitoring systems, so that people cannot doctor shop. They say its for medical reasons, but just ask the DEA who is in bed with insurance companies. I could go on and on, but I won't bore anyone with the details. Hubby's home after a 14 hour day and the twins and me want to hang out with daddy before their bedtime.

Night everyone!
Anonymous on 2010-09-12:
I truly believe that the doctor's hands are tied when it comes to dealing with the insurance companies. I can't tell you how much money we spent fighting back and forth to get some claims paid. Besides, the doctors are more concerned with medicine (at least the ones I worked for) than fighting the bureauracy.
Anonymous on 2010-09-12:
I agree Sing, and with this new health care bill the insurance companies are going to get away like bandits you are now forced to sigh up with them and since they can't deny claims for preexisting conditions anymore they will just jack up your premiums till you can't pay em.
LenaSunShine on 2010-09-13:
@Skye: I'm sorry, I thought you missed my point because you wrote, "That is so not true. There are actually doctors out there, who went to school to help others. It's not always about the money for them." You didn't say specifically what you thought was "so not true," and I did not make any comments about the reason doctors went to school, nor that it was only about money for all of them, it appeared to me that you were not responding to my actual post.

I know what you mean about the lack of privacy, the DEA, and so forth and I am the same: "don't get me started." It is enraging, and it is a colossal waste, interferes with our medical treatment, compromises us, and lines pockets other than medical professionals'.
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Horrible Benefits!
Posted by on
Rating: 2/51
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 comperable 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 woulnd'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 Baby Clutzy Deux to my list of dependants 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 [snip]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 Baby Clutzy 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 Baby Clutzy 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!
     
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Josh on 2013-06-12:
I have never had a dental plan at any employer that paid out more than $1000 a year per person. That is typical and has been around that same amount for about 30 years. Dental plans are not insurance and unlike medical insurance, they do not keep up with the rising costs of dental care. Best action to take is regular dental visits and good routine home dental care. Avoid sodas, sugar, etc and floss and brush 2-3 times a day.
John Nicholson on 2013-06-12:
Welcome to the world of dental insurance. Most of the time they are a real joke, paying little. In your case, don't blame the United Healthcare people, they only cover what they cover. Your problem is with not only the HR people at your husband's work, but with your husband for not finding out what is going on with the insurance before the open enrollment period ended. The people at his work most certainly knew what was going on and I suspect he didn't bother to try to find out about the new year but just "assumed" all would be the same as before. You snooze, you lose. By the way, keep the milk bottle and pacifier away from the child. As well as any juices.
yoke on 2013-06-12:
Dental insurance is a real joke. But I also blame dentists, sorry. I don't trust dentists and they know you will be paying out of pocket for a good portion of the service.
How can you go for regular visits and have one dentist tell you your kids teeth are excellent and then 6 months later have to switch dentists due to insurance and this new one tells you your kids have a bunch of cavities? Who do you believe?
Also think it is disgusting what Orthodontists charge knowing the insurance only pays $1,000-$1,500 of it.
Then when the kids need the wisdom teeth out again a good portion is out of pocket.
OK my vent is over, lol
clutzycook on 2013-06-13:
Josh, I'm telling you that if we had the dental plan through my job, they would have paid out 3,000/yr/pp.

John, he tried and they either couldn't or wouldn't give him any info. According to the line they fed him, they didn't know for sure until a couple days before. But that's par for the course at his job. If we had had an inkling this would be happening, we would have gone straight to my benefits. And BTW, being a nurse, I know all that about juice and milk and bottles. I spent 2 years arguing with my husband about that but he thought that with his biology and chemistry degrees he knew better so here we are. And yes I laid into him after we got done at the dentist.

Yolk, tell me about it. We were just discussing this at work today. I think a lot (not all, but a lot) of dentists were MD wannabes and now they're stuck. Why else would they have the highest suicide rate in the healthcare field?
Nohandle on 2013-06-13:
You guys are way ahead of me because I never worked with a company that offered Dental or Vision Insurance. It was not a pick and choose what you personally wanted, it was all or none for the group plan. We did have excellent Health Insurance and the employee did not pay any premium whatsoever. It was called a job benefit. I don't think the younger employees really appreciated it but I also don't think they knew any better at the time.

I think with any insurance now most among us don't have a clue as to what's going on, I certainly don't. I feel for any of you having to deal with all of it, especially those with children and elderly parents to care for.
DAHealthInsurance on 2013-07-22:
Clutzy,
Sounds like your blaming United Health Care, they aren't in the "dental business" so-to-speak. Your husbands company should have had other alternatives than the dental plan that was offered through his primary insurer. I have had several companies offered for dental over the past 20 years, and none of them pay a lot towards dental work. Cleanings, x-rays, etc., yes. But when it comes to major dental work, not much at all. I have chosen to "self insure" my dental work, I set aside $150 per month and I don't touch it until I need it. I use a dental discount card and my kids have had some work done to the tune of about $2K over the past 2 1/2 years, but I know it is going to happen. You can either pay yourself or pay the insurance company and get the surprise later, its up to you. I am an insurance agent and United Health Care is one of the best companies I use for my clients Medicare options. I think it is unfair that you have them a low rating based on this situation alone. They offer more benefits in the Medicare side and the lowest rates with the lowest average increases year after year than any other company I have worked with. Sorry the situation you were backed into caused a poor result with UHC.
DAHealthInsurance on 2013-07-22:
Oh, also... Just because another company offers $3,000 per year, per person, doesn't mean it would have covered your whole dental bill anyhow. You have to look at what procedure was done and what percentage of THAT procedure would be covered. May be more with UHC than other per occurrence? That is why they give you a Statement of Understanding so you can compare plan to plan. Maybe this will help for future...
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UHC AND OPTUMRX
Posted by on
Rating: 1/51
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 83323294. The UPS tracking number is 1Z04W515NW44694700.
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.
     
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David on 2013-12-30:
I have been stuck with UHC for the past three years. Before (on Medco) I was paying $360 every three months on insulin. It is now $4,000 I'm a single parent with 2 kids. Someone is getting rich my friend, unfortunately it surely isn't us.
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Make that "NEVERCARE"!
Posted by on
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!
     
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Anonymous on 2009-03-18:
As terrible as the medical system is in Canada, I'm always grateful for provincial health care, knowing that my health will never be dependent on what an insurance company or HMO deems suitable. I really hope for you and your mother that the new insurance company works out. I imagine it is stressful enough dealing with Alzheimer's without having to worry about whether her medication etc. will be taken care of. Best of luck to you and your mother.
jenjenn on 2009-03-19:
Premium free insurance? Promised coverage? Did you once ask for a summary plan description? I would want to have the plan info in writing before I signed up for anything.
MaryBronnimann on 2009-06-05:
When I started having trouble with Secure Horizons, I went back to the policy materials they had sent me to find out what was covered....The material was so vague that they could probably avoid paying almost anything. What scam artists.
Lisarnccm on 2012-08-03:
CareMore is horrible
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Do not accept employment from this company "Evercare"
Posted by on
NATIONWIDE, OHIO -- I was a Mid-Level Practitioner for this company (Evercare) for nearly 9 years. I was responsible for 6 Nursing Homes across 2 counties 45 miles apart. If you think you can see all your patients daily within 8-10 hours a day you are dreaming. It is a crime that the entire Evercare Field personnel are overworked, and the Evercare portion of United Health Care is a revolving door. In my Tenur there I had seen a complete turnover 3 times. The pay ranges are adequate to start, but forget a yearly raise, even to the effect of a cost of living adjustment. They also are of the mind set to go after anyone who questions their practices. If you do not like it, as a "at will" employer they will say "if you don't like it leave". What they forget is we are dealing with the sickest, most difficult patients. I would recommend to all the Nurse Practitioners and Physician Assistants to find another orginzation to devote yourself to, someone who cares about its employees and value their devotion to the Patients. I for one worked 60 hours a week on average and after nearly 9 years I said enough, as I had seen so many great people used, and thrown aside. Now all they hire is new grads from school who are looking for the "First Job". I have been in this occuapation many years and am nearly 60 now. This is the worse company I have ever worked for in regards of employee value. I guess I bought into the fact that they were attached to a Large insurer. Just look at what the CEO is making yearly. $48 million dollars...I guess he must have gotten the yearly raises from everyone...Am I bitter? Hell Yes, the system is broken and needs to be fixed.
     
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SuzeB on 2011-10-27:
Comparing your salary to that of the company CEO will drive you crazy.
M B, RN on 2012-06-18:
Thanks for the insight. My employer, a large nursing Home, had us attend their spiel today. Of was presented by a young fashion train wreck whom evaded any good questions asked. She was adamant that we approach residents and their families to 5enroll. Consensus is the hell we will!
toto on 2013-02-16:
I interviewed with this company exactly 4 weeks ago today. I showed up to the interview on time as planned by the NP recruiter. I emailed them and texted them that I was there and figured since I was not receiving a return email or text that they must have forgotten my appointment. I had just walked out the door and got a call on my cell from this lady wondering if I was still there!! Turns out She and the physician I was to be interviewing with were interviewing another NP candidate during my appointment time. The other NP showed up early and they decided to go ahead and interview her. I waited for an hour as I had no idea where they were. The meeting was held in Panera Bread of all places!! I thought this was odd anyway. I turned around and came back in . I interviewed very well as I had an interview coach. I even asked them how I did. Both stated I interviewed very well and they said my experience would be just what they were looking for. So I waited for a few days and emailed them both thanking them for the opportunity. No email response . I again emailed them both 2 weeks later as they promised me they would let me know in 2 weeks whether or not I got the position. I never received an return email from the physician or the NP recruiter. I then waited another week did the same and finally yesterday decided to email the physician and I guess he realized I was not going to given up and today finally got a response that they chose another candidate with more experience. When I look back at some of the things I discussed with them during the interview I remember discussing my near miss experience at almost being hired at a really shady workers comp practice with no one to mentor me and that the physician that was supposed to be my "collaborating physician" appeared to me to have dementia. I also stated after shadowing there for one day I realized that it would not be for me because I felt it would not be ethical to work in that type of situation.. for various reasons one being the standard care arrangement was very shoddy and I had my attorney put one together.. I expressed to them that I play by the book and I am now so glad that I found this review, because I was at first disappointed, but now I am relieved that I missed that bullet!
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United Healthcare Sucks - Worst Company There Is
Posted by on
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.
     
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Alain on 2010-08-30:
Call your states insurance commission/agency for their advice on how to proceed with this. Also give the American Cancer Society a call at 800-227-2345 to see if that have some ideas since they may have seen this type of situation before.
Venice09 on 2010-08-30:
This is a good example of what people have against health insurance companies. They are not in the business of health.
Robin on 2011-05-27:
I have had this poor excuse for insurance since February, I was told that my Dr would take UHC option 1. My dr made a claim and it was denied, it was just a regular office visit. I decided since they would not cover a regular office visit I would cancel this, I tried to cancel but I was always sent to an extension that did not exist. it would just give a busy signal. I tried to call the # on the statement that declined my claim. The same thing happened I got a busy signal. So I called Visa to stop paying UHC, I also told them to do a chargeback for the previous 3 or 4 months. Visa informed me that I was probably going to lose my case. I don't understand why I am not protected by Visa, when it clearly is a case of fraud. They lie to you to get you reeled in, take your money, and don't provide service. I have a very limited income, as I am now disabled, why is it legal for them to take my money and not cover a simple office visit.
mable on 2012-06-20:
IN MY OPINION THEY ARE THE WORST COMPANY ON THE PLANET, THEY REFUSE TO PAY WHAT THEY ARE SUPPOSED TO EVEN WHEN YOU PROVE TO THEM THAT THEY ARE BY CONTRACT OBLIGATED TO PAY. HAVE BEEN BATTLING THEM FOR TWO YEARS. PEOPLE DIE WAITING FOR THEM TO PAY. STATE AGENCIES NEED TO INVESTIGATE THEIR UNSCRUPULOUS BUINESS PRACTICES.
Emily Jensen on 2013-12-11:
This is the worst insurance company ever. Even our Mayo Clinic doctors were given the run around until they finally gave up trying to get authorization for services that should have been covered according to our PPO. Many times we would call and just get disconnected. Optumrx is even worse as their new mail order pharmacy. Absolutely terrible customer service. I'm so glad that my husband's company dumped them and went back to Blue Cross Blue Shield. United Healthcare needs to be shut down.
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Complete Incompetence
Posted by on
Rating: 1/51
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 (Toni) 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.
     
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Paul on 2014-01-25:
Never dealt with UNH for prescription issues for my mother, but the rest of the story fits like a glove. UNH was her secondary healthcare insurance, and dealing with them to resolve issues usually took at least three phone calls, going through multiple menus and representatives, being given incorrect information, reps saying they would do something but not do it. It was a total nightmare. Not going near that company ever again. They probably have millions and millions of customers and won't miss my business.
BigAl on 2014-01-29:
United Health Services is a scam. I am currently in the middle of a mess caused by them. As soon as I have the time I will post my problems with them. Stay away from them. The government should close them down.
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Out of Pocket Expense
Posted by on
Rating: 1/51
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.
     
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Don't Use This Medical Insurance
Posted by on
Rating: 1/51
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.

Steve,
Marquette Michigan
     
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Alain on 2013-01-15:
Contact the Michigan Office of Financial & Insurance Regulation consumer hotline at 877-999-6442 and see if they can't give you some assistance in dealing with United Health Care. You may be able to contest their denial of payment.
Vinnie11 on 2013-01-15:
I also have United Healthcare @ $490/mo with a $3500 deductible. I feel your pain. My daughter was in ICU in August and somehow that $3500 deductible resulted in my spending $10k out of pocket. Then I became ill and had surgery and found out the deductible is $3500 INDIVIDUALLY so I had to shake the money tree and come up with some more. Their trick to delay payment is to say that the medical institution sent the claim to the wrong address or whatever and to resubmit dragging the process out for months and toying with my credit. What I REALLY want to know is what the heck is ObamaCare and how does it fix this? If you are not VERY poor, you're just screwed.
Obsfucation on 2013-01-15:
"Golden Rule should be called Golden Shower"

That alone made the review worth reading!

It might be worth pushing back a little and questioning their decisions, and document the reasons they denied payment. Sometimes you get surprised.
Susan on 2013-01-15:
Ultimately it is your responsibility to read and interpret your policy and verify what is covered and at what percent prior to utilization. I'm not saying your insurance isn't expensive and/or doesn't seem to cover much but unfortunately it is paying what you agreed to when you signed up for the policy.
Vinnie11 on 2013-01-16:
It's not that simple, Susan. There are all kinds of nooks and crannies not covered in the plan docs. For example, my mother and I had the EXACT same surgery with the EXACT same doctor. But after mine, they sent to the doc for my records and deemed mine "cosmetic" and not medically necessary and didn't cover it. I had to appeal. I ended up paying for it anyway but as a result of the appeal, it met my deductible for that year. Then you are punished with a rate increase. Individuals aren't protected under the umbrella of guaranteed group rates. They raise our rates and they raise them frequently. If they find out you have a "problem" they don't cancel you, they raise your rate until you can no longer afford it and cancel them. The industry needs regulation and they need it fast.
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World's Worst Health Coverage
Posted by on
Rating: 1/51
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.
     
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Susan on 2012-10-14:
What does your policy specifically state regarding whether or not your deductible excludes the cost of x-rays whether or not they are performed at an in-network facility?
clutzycook on 2012-10-14:
So did you call them and see why you got a bill?
Starlord on 2012-10-14:
It is not United's fault that labs don't do the complete job at one site. As far as not incurring the deductible, dream on. My Medicare Complete policy is insured through UHC, and I am very happy. You just have unrealistic expectations.
Anonymous on 2012-10-14:
Going to an in network facility doesn't mean you are covered 100%. You will still have a deductible to meet. And labs don't perform X-Rays. So you will have to go to an imaging facility for the X-Ray. Imaging facilities don't perform labs. Not United's fault.
wjk898 on 2012-10-14:
What kind of policy is it? My UH deductible means anything and everything applies to the deductible after which they cover eveything. At humongous cost of course!

Not that it makes it any cheaper, by the way. Health insurance has become money extortion in this country and nobody is saying or doing anything about it. Do you know where that money for your health insurance policy goes? Do you know anything about the financial activities of your health insurance company? Of course you don't. Nobody questions why health insurance is more than double what it was 10 years ago...with NO and I mean NO NO NO big difference in costs paid to physicians, nurses, and all the other people who actually do the work! Biggest fleecing I've seen in all my 60 years. And nobody is asking questions. Obamacare is NOT the entire story - and in fact, mostly touted as an excuse! This business of escalating premiums - through the roof! predated Obamacare and nobody is calling out these crooks. $13,000 a year for an individual policy? Are you people nuts?
Discerning Consumer on 2012-12-02:
Beware of the UHC beast. I have witnessed first hand of their tactics. I had a favorable opinion became an employee . I became an employee and saw their deliberate miscommunication with enrollees and upper management condones it.I quit after nine months because I have a conscience!!!I tell all seniors I know to beware of the Beast-UHC.
Terry Smith on 2013-07-30:
Thank you for being truthful!
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