MARKET PLACE, FLORIDA -- WORST, WORST, WORST experience ever! Here's my experience... (Personal information has been changed for my privacy). 2012 - Signed up for individual insurance for "Suzy " (female) with United Healthcare Golden Rule. March 2015 - Signed up for individual insurance for "Suzy " (female) with United Healthcare MarketPlace. - March 2015 - Marketplace plan was started, and month 1 paid. ID **. March 31, 2015 - Marketplace plan was terminated without communication to either Suzy or Stewart. March 2015 - No payment made to United Healthcare Golden Rule.
May 2015 - Suzy realized she never received an insurance card from the MarketPlace and could not log in to their website. May 2015 - Stewart (Insurance Agent) and I ("Suzy Anne " (female)) called United Healthcare MarketPlace regarding plan established in March. Response was that the plan never went through, and a new application was filled out over the phone. New application used the wrong name (Anne as the first name, as the surname, no mention of Suzy) and indicated insured was a male. Suzy paid $713.72 to cover the balance from April and May. ID **.
May 2015 - United Healthcare mailed Suzy 2 letters regarding outstanding balance of $38.62 and a period of 10 days to pay the balance. Suzy was out of the country and did not receive either letter. No communication was made via email or telephone to either Suzy or Stewart regarding payment issue or coverage termination. July 20, 2015 - Physician office calls Suzy regarding insurance had been terminated. ID **.
July 20, 2015 - Suzy and Stewart call United Healthcare, call was disconnected. Suzy called United Healthcare back and spoke with a customer service. She was advised her insurance had been terminated for lack of payment. Bank statements indicate a check for $224.11 was mailed to United Healthcare each month, yet according to the United Healthcare representative, none of those payments were attributed to Suzy 's account. According to the bank, they were all cashed. Suzy was advised to send an email and explain the situation. An email was sent (to firstname.lastname@example.org) and Stewart was carbon copied.
July 21, 2015 - Email from United Healthcare was received by Stewart that read "We will make the exception to reinstate without lapse with the additional $38.62 and the June payment of $262.73 for a total of $301.35. The insured can call and pay with a cc payment today or they can send a payment to us to be received by the close of business on 7/23/15, after that date we will not be able to reinstate without lapse."
July 21, 2015 - Suzy called United Healthcare, paid $301.35 and was advised her account would be reinstated. This reinstated her Golden Rule account from 2012 (ID **), not her most recent MarketPlace account. Suzy was transferred to the MarketPlace, however after speaking with someone and waiting on hold for more than 30 minutes, the call was disconnected. Prior to being disconnected, Suzy was advised that she paid $713.72 in May, and her account had been terminated at the end of May.
July 22, 2015 - Suzy called United Healthcare Marketplace to get reinstated. She was advised that her account (ID **) had been terminated in March. The representative advised a new application would need to be filled out. They found Suzy's name was written as Anne and she was identified as a Male. The call was disconnected before the application could be completed.
July 22, 2015 - Suzy called United Healthcare Marketplace to get reinstated. She was informed that there was nothing she could do as her insurance had been terminated. Call transferred to Tier 2, who sent a request to United Healthcare Case Management to reinstate insured. Suzy was advised the process could take 1 - 2 months. No record of May's payment or Golden Rule account was found. July 22, 2015 - Suzy called United Healthcare Golden Rule to confirm insurance coverage secured the day before (July 21, 2015). Her ID (**) could not be found in the system.
July 24, 2015 - Suzy and Stewart called United Healthcare MarketPlace to discuss coverage. Their system did not reflect calls from earlier in the week, nor did it correct the name "Suzy Anne" and "Anne." Service representative Lance advised call would be elevated to someone that could problem solve and worked on odd situations; United Healthcare MarketPlace should be in touch with Suzy in 5 - 7 business days with a resolution.
July 28, 2015 - Case management called and left a voice mail. Name (first name only) was not understandable. Did not leave a case number. Call was to informed me they had my case and would be working on it. July 27, 2015 at 6:20pm. Called number left on the voice mail (877-887-0441), no notes regarding case management, case manager or case number. Called number that called me (**), call was disconnected.
July 31, 2015 - The MarketPlace called to inform me my application has been updated. Marketplace has updated my application. Sent the application and a request for reinstatement to the UHC. Have to work with UHC to get reinstated. Has no information about payments, old policy ID number. At this point I have to work with the plan (aka UHC). Name and sex have been corrected. No idea who at UHC I need to talk with. Advised her that my policy got messed up because the Golden Rule and MarketPlace systems didn't catch the error in my application.
She asked why not, and I said it was because the systems don't communicate and neither do the people. She said I would need to work with the insurance plan. I asked who that was and she said the plan. After asking for clarification again, she said it was UHC. I asked which department at UHC I would need to talk with since if I called then and said, I need to talk with the Plan, they would think I sprouted a second head. She said she didn't know, she wasn't part of their company and doesn't know their departments. She doesn't communicate with them.
July 31, 2015 - United Healthcare called. Received a file from the MarketPlace on 7/15 showing termination should have been 3/31. As of today, UHC has not received anything from the Marketplace. If the Marketplace sent something, it will take about 30 days to process. July 31, 2015 - A letter from Golden Rule and check came in the mail today. The letter states that I am paid through July 31, 2015 and in fact overpaid by $224.11. The check is for $224.11.
Here are the issues: This payment was made through the website that we set up access to while on the phone with the Marketplace in May 2015. This payment was applied to my old Golden Rule account from 2012. I was dropped from the Golden Rule account in May for non-payment. The Marketplace won't show record of this payment. I also received a letter from the Marketplace that says I am eligible to re-enroll in January. This is the first communication I have received from the Marketplace.
March 2015 through current - Suzy never received any communication, a new card or an invoice from United Healthcare Marketplace. March 2015 through recent - United Healthcare Golden Rule has been charging Suzy for an old plan, collecting payments and not attributing them to her account.
Sent them: Bank payments for United Healthcare Golden Rule. May payment for United Healthcare MarketPlace
American Express payment for $301.35 for United Healthcare Golden Rule, made July 21, 2015. Total paid to United Healthcare 2015. Jan: $224.11. Feb: $224.11. March:. April: $224.11. May: $224.11 and $713.72. June: $224.11. July: $224.11 and $301.35. Total: $2,359.73. Marketplace premium: $356.56. Owed to United Healthcare for = $-35.85.
SALT LAKE CITY, UTAH -- I am so surprised to see bad reviews! I had this insurance in 2014 through my husband's employer and ended up needing a hysterectomy in December 2014. My husband's employer had already decided to switch insurance companies in Jan 2015, so I was in a time crunch.
I went on Dec 8th for pre-op evaluation, and my surgery was scheduled for Dec 18th. Unfortunately I found on from the hospital on Dec 17th that the insurance had not yet approved the surgery, because pre-approval had just been submitted by the doctor's office that morning, the day before my surgery.
I called the insurance company in tears to get this surgery done, as I was in pain, and I was told she would do everything possible to get it taken care of. I also stupidly disclosed that we would be changing insurance companies in a couple weeks and I didn't know what the coverage would be and I had already met my out-of-pocket annual maximum - a perfect reason for them to delay approval to not have to cover.
Imagine my surprise to get a call at almost 8:30 pm (well after closing time) to tell me it was all taken care of, I could have my surgery the next morning. Surgery was done, bills were paid, no problems. A few months later the anesthesiologist was billing me, saying my insurance didn't pay them. I looked at the EOBs, which said I owed them $0 due to network discounts, so I called and told the provider this. They said OK, no problem.
A few months later (after my coverage ended) I got a call from the anesthesiologist again saying I owe, and that they are not in network with my insurance. I called UMR and they got on 3-way call with me and the provider and told them they are in network. The anesthesiologist office said "I don't care. We are billing it."
True to their word they sent me to a collection agency. I told them what happened (Note this was almost a year later, long after coverage was terminated with this plan). I called UMR and they send documentation to the provider showing their in-network status with a copy of the contract. The collection agency continued to call and I continued to explain to them and they told me to call the provider, which I did, and they said they would look into it, which they didn't.
Fast forward to today, March 2016, 15 months after my procedure and the termination of my UMR plan - the collection agency said I need to send EOBs to show I don't owe the balance by the end of the day or my credit is going to take the hit. I called UMR with no ID, no active plan, and no benefit to them whatsoever and spoke with Natalie, a super sweet woman who looked up all EOBs for anesthesia (as they did not bill under their business name, but under a provider whose name the provider couldn't tell me), and she faxed the EOB immediately and waited on the phone to make sure I got it. I faxed it to the collection agency; game over - I win.
UMR reps were always understanding, helpful, accommodating and expedient. I know they say people are more likely to leave a bad review than a good one, but I believe this company definitely deserves credit for the assistance they provided me, and continue to provide long after my coverage was ended. I would recommend them to anyone looking for good customer service.
TENNESSEE -- My father needed to have a CT scan per his doctor to make sure that his cancer (has been cancer free since 2000) had not come back. His claim was denied by United Healthcare. The reason stated was "You have cancer in your nose and throat area. You have neck pain. You have a sore throat and pain in the roof of your mouth. Your provider suspects spread of "cancer" to your brain. Your provider asked for a CT scan of your head/brain with and without a dye called contrast."
The letter goes on to explain what a CT scan is and what a MRI is and then states that "cannot be done for medical reasons and you have a brain function problem such as mental confusion, change in vision, slurred speech or a new severe headache."
My father receives this notification and is devastated!!! First of all, he went the doctor with throat and pain in the roof of his mouth. He NEVER complained of headaches, mental confusion, change in vision or slurred speech. He contacted his doctor and the head nurse called back and apologized over and over again since the information that was sent to him was a LIE!!! She confirmed that no one in the doctor's office provided that information to United Healthcare. It appears that someone that works at United Healthcare falsely added this information/LIES to his records so that the medical services requested would be denied.
I am sure this is not the first time that this has happened to customers of United Healthcare. Please do not use United Healthcare for your medical needs because they falsify medical records so they do not have to approved medical services or items. How many others has this happened to? Who can help with this type of fraud?
SALT LAKE CITY, UTAH -- United Healthcare mailed me five provider appeal requests I never made. I got four in November 2014 and the last one dated December 5, 2014. First one gave the name of a company and said I made a complaint against this place and said they sent a decision explanation and since it was a duplicate, I couldn't appeal it. What complaint and what duplicate complaint? I've never made one. I faxed UHC in November 2014 and informed them that I did not make a report and for them to correct it. Ignoring tactics they use. They sent me four more of the same.
They were dated November 4, 7, 17 and 25, 2014. UHC indicated they put them in my patient ID files. The last one was December 4, 2014 and dated with an individual's name as provider appeal request I never made. I faxed provider complaint on a horrible P.T. records content that UHC had paid for and last phone contact about that was October 27, 2014. Last fax regarding that was November 2, 2014. I never heard back on the issue about P.T. session.
I got harassed by UHC with nut job fake reports instead, gee I wonder why. Also November 3rd and 4th, I got two phone messages to call UHC about another made up nonexistent report. Saw bad scene, I was done with UHC. No more phone contact and I looked for another insurance. I would have had to have made a report and received a letter back on an appealed decision in a specific time frame long before the P.OT.. complaint to have even exist, which it was not.
They have NO phone connection or faxes or letters on fake reports. I got 2 answer machine calls on December 5 and 8, 2014, from service coordinator UHC, phony, prank sounding message telling me to call her about my requesting multiple therapy times. I never did! I stopped all calls. October 27, 2014 was the last and only sent a few faxes November 2014 for UHC to take reports I did not make out of my files. And I did not of course, pursue initial complaint.
I left UHC in December 2014. They also apparently sent me to physical therapy two other times , pulling a stunt of having my significant medical condition completely left out and had my other med files hoaxed with as medical conditions magically deleted. My only opinion is all of the above. I have all of my medical records however. I've been trying to get all the fake files out and straighten the records out through other places, but not able to yet. I have not gotten five fake file reports I never even made. I do not have anything to do with UHC!
MINNESOTA -- I have received yet another denial letter from UHC in response to my BBB complaint. They basically rehashed their denial stating it was just an "estimate" and referred me to the "Why Costs May Vary" section. I would understand if they gave me a different amount for my Out of Pocket expense (say $100 & that in actuality it turned out to be $150), but they told me it was 100% covered for a 57 yr. old & that my Out of Pocket amount would be $0.
Had they told me it was only a covered benefit for adults 60 yrs. of age or older or that it would have been 100% covered if I went to the pharmacy to get the shingles vaccine, I would have waited the 3 yrs. (now 2 yrs.) to get the vaccine or gone to my pharmacy where it would have truly been 100% been covered. They gave me the wrong information & will not accept responsibility for their mistake. I was never given the external review from someone outside of UHC even though I had asked for an external review 4 times.
They have basically given me the runaround for 16 months in the hopes that I will give up. They hide behind jargon and twist it to their advantage. Any average person being told "Good Job on Preventive Care" & that the shingles vaccine is 100% covered with $0 Out of Pocket expense would assume that it is a covered benefit. Why would you think otherwise? They are exhibiting "bad faith" all around.
After all this, wouldn't it be a sign of integrity and responsibility just to pay the $210 instead of spending probably hundreds of man hours and dollars to continue to deny the claim. Every correspondence ends with "Your satisfaction is important to us." That is so very far from the truth. If that was true, they would have paid this claim long ago & not ruin my credit by having the claim go to a collection agency.
MARYLAND -- To start off, I've had terrible experiences with United Healthcare since I started their coverage a few years ago. It's come to a head recently after a coordination of benefits issue meant that they paid a hospital bill for my husband and then retracted the payment from the hospital. TWICE. Now the hospital, of course, is coming after us for the 6,000+ bill.
I have called and emailed countless times over the past 2 months. I've sent emails. I managed to get direct lines to 2 different people and have been leaving voicemail after voicemail, which has been ignored. I've sent the paperwork and letter from the other insurance company verifying the coverage dates and confirming that United is responsible for the bill. Nothing. And the hospital is threatening to sue us now b/c it has gone on for so long.
Finally, today, I left a nasty review on their FB page. I didn't really have much hope for this other than maybe warning others to try to find different health insurance. Not 10 minutes after I left the review, a member of their social media team contacted me. He got all of the information on the problem and filed an escalated ticket to get it handled quickly. AND he called the hospital and they've placed a 30-day hold on the account, with no collection activities, to give United time to deal with the coordination issue. So, what can I say? Um, the rest of United is TERRIBLE but their social media department is great, so far anyway.
PENNSYLVANIA -- I have already written to the CEO of UnitedHealthcare so I will be brief. This company has been stupendously inept. Here is a summary of their excuses for not paying...
Each correction to their process takes an entire billing cycle - hence 10 months have elapsed with still no resolution. The hospital has lost patience and started debt collection proceedings against me. UHC assured me they would expedite a "Cease to Bill" letter - I have had to ask twice and still no letter after more than 2 weeks. I have noted everything so next I will be taking my evidence to the Ombudsman.
KINGSTON, NEW YORK -- The company says they cover hearing aids. They say in their contract they will give you $1000 per ear over a 3 year period. The problem is that they will not approve any hearing aid purchase over $1000 dollars per ear and won't let you pay the difference out of your pocket. They only allow your Dr. to bill you $1000 per ear and cannot charge you amount over that.
They try to force you to buy hearing aids from Hi-Health innovations, that is a subsidiary of UHC (A SCAM). The hearing aids are cheap, ($800-900) per ear and will not work for me. The FDA has a cease and desist against this company for wrong practices. They also try to force you to get other very cheap hearing aids that will not work for me.
My audiologist has gotten burned many time by UHC and is even an in-network Dr for UHC. My Dr has not one good thing to say about the company. Most companies don't offer hearing coverage, but if they say they do, then they should and not mislead you or force you to buy what they want you to wear. I think it time to shop around for better insurance. I hope a lawyer looks over their contract and makes them change the wording in their contract.
SOLANO COUNTY, CALIFORNIA -- United Healthcare takes over your Medicare makes decisions on your medications above and beyond your physician's recommendation. The pharmacy Optum RX has denied 2 of my 90-day supply medications informing me that the 90 day of each of these 2 medications were all I was going to get for a year supply and all refills are denied. My physician has appealed this decision and it was disapproved.
I am going to appeal the decision once again but these actions are causing undo stress and anxiety. I am retired and my insurance is through Calpers I had to change plans because my previous Blue Shield Ins. hadn't signed a new contract with my physician's medical group Sutter Regional. I feel sorry for anyone that has to deal with this insurance co. I wouldn't even give this company one star. I cannot wait till open enrollment and get my Blue Shield back. Someone needs to look into an insurance company that defies a physicians diagnosis and prescriptions. I writing this because if anyone is considering United Healthcare they might do a little research first.
I signed up for the $400/month bronze plan with prescription savings plan... once I signed up for that plan, I then found out it doesn't cover mail order prescriptions, or most prescriptions in general. I called for assistance and basically was told, "sorry we can't do anything..." I basically was lied to or tricked prior to signing up for this plan, and now each time I call it's basically "too bad for you". Also, while applying it asked for my pcp, so I put their name in. Have been seeing this specialist for years now. They put some random doctor as my pcp. Never heard of him.
Was told I cannot change it to a specialist, has to be pcp.
So now I guess I have to go see some random doctor. I don't know to get prior authorization for some of my medications. Which makes no sense, because in the end the health insurance is basically paying for a random doctor when I have my own. I can't wait 'til next open enrollment so I can cancel! I am in the healthcare field, and I make sure I tell everyone about my problems with United Health.