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.
PITTSBORO, NORTH CAROLINA -- This letter will be copied and placed on the webpages of all companies. My story begins almost a year ago. My husband (a Duke Internal Medicine patient) was scheduled for a follow-up colonoscopy after having multiple polyps found the year before. In the course of the year, my insurance changed and we secured Marketplace insurance with United Health Care. This was premium insurance, very expensive monthly premiums and a $250.00 deductible.
The provider's office did a referral, and here is where the water goes murky. Duke, at the time did not take the type of UNC insurance (compass platinum), so an appointment was made via the providers office with UNC healthcare. My husband called UHC prior to the visit to make sure the paperwork was in order and was told "the procedure was a covered 100%". He had the procedure, and received a bill. Part of the bill was covered but 2900.00 was not. Upon investigation per UNC, the referral was for a screening, not diagnostic and needed a new number.
The provider office said the referral did not need a number and would look into it. UHC said the referral was not correct as well. After multiple phone calls with all three groups and a lot of finger-pointing between companies, the bill was turned over to collections, and UNC will not return phone calls.
A customer service representative from Duke has also looked into the situation and told us today, everyone is blaming someone else. Here is the sad thing, all these companies advertise "patients first, patient centered care" etc. The patient should not be responsible for making sure referrals have a correct number, should not be responsible for making sure codes are correct. He did due diligence to make sure prior to the procedure that it was covered.
The final disservice and disrespect to the patient is making them jump through hoops to find out no one is accountable but him. $2900.00 may not be a lot to some, but it is a lot to us. Add the monthly expense of the insurance premiums, for what should be covered and this is shameful.
My daughter has seizures, and the original medicine she was prescribed (which UHC covered) caused bad side effects. She would turn into a different person for the first couple hours after taking her medicine. She was almost manic! As the medicine wore off each day she became depressed and mopey. Her school work was also suffering, and the teachers were asking us if there was a problem. She had previously been a good student and all the teachers loved having her in the class. This was at a low dose of the medicine, as the doctors were ramping her up to the normal dose for a child her size.
After discussing with the neurologist, he then prescribed a new medicine. The new medicine was the same as the old, except it was time release. With the new medicine she has gone back to her old self, and doesn't experience wild mood swings. Unfortunately, UHC will not cover the time release medicine. Because the time release medicine contains the same ingredients as the cheaper first medicine, they will only cover that medicine. We have appealed, with doctors and teachers writing letters to describe the side effects of the first medicine. None of this matters to UHC.
We will continue to pay the $650/month for the time release version. We are lucky enough to be able to afford this. However, I feel for those in the same situation who are being denied and can't afford it. We probably would take her off the medicine completely and risk further seizures if it meant going back to the first medicine. Prior to this happening, UHC denied my cholesterol medication. This medication had previously been allowed by Humana before my company switched providers. My specialist told me I was better taking an over the counter version instead of the medication UHC would cover.
However, he recommended I continue to take the non allowed medication. I did continue to take this medication until we had the issue with my daughter not being covered. At that point paying the monthly amounts for both was not an option, so I have discontinued the cholesterol medication. UHC has a well-earned reputation for not covering medical necessities. They offer lower premiums to companies, and then make up the profits by not covering items the doctors feel are important.
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.
SALT LAKE CITY, UTAH -- If you can find anyone else to get your insurance through, do it! I have them through my workplace and they are TERRIBLE! I have never had an insurance company make you jump through so many hoops to maintain coverage. Every time I turn around I have to verify that I don't have any other insurance coverage. Now I have to send in a marriage certificate, copies of tax forms, "proof of ownership", and birth certificates just to prove to them that I have dependents. What the ** do they think I am paying them for? If I didn't have dependents, I wouldn't be paying their inflated rates!
If you have a claim, then it gets worse. They deny everything and then make you do all the work to try to get them to approve it afterwards. They will never contact you first regarding any information. No wonder they had to refund money because they made too much profit. They make their profit by failing to pay out for coverage you pay them for.
FLORIDA -- I had to changed to my husband's insurance since I retired. I have taken ** for undiagnosed chronic pain. I have pain in my right shoulder, my lower back mainly on the right side and pain in my right ankle. During a trip to Wyoming, I pinched the nerve in my lower left back and had horrible pain shooting down my leg. I have seen two specialists and had three lumbar injections and two nerve procedures where they burn the nerve connections. I take ** and ** for the pain.
Now United Health care is denying my ** because I don't have nerve pain due to injury to spinal cord. Also they state if I can't take a tricyclic antidepressant or ** I am legible for **. Guess what! I can't take either. And I have chronic nerve pain. Go figure.
USA, MARYLAND -- Coverage ended 2/28/15 with $0 premium balance due. May 2016 got premium balance due $60.52. Able to still go into UHC account to print payments made from 2014 - 2015 time of coverage. Found they changed payment amounts. Still had emailed payment confirmations also. Had to get CC statements to prove amounts. Called UHC. Talked to Jessica to tell her I am waiting for CC statements since I went paperless and it is almost 1 1/2 year later. Please note my account. "No problem" she said.
Next day Mark calls from UHC asking for payment. WTH!!! Both times I feel they pretended to note my acct. I spoke with James 7/18 to say I have proof payment made but amount changed. He informed me I can only and repeat only send my proof via email or fax! No mailing. WTH again.
I'm lost in words since I had reported them when we had them for making coverage a nightmare. State Attorney's Office short staffed and because I was no longer with UHC they could not investigate them. Bull. So I am hearing others having the same issues with not paying for script, need preauthorizations again & again. Saying they did not have payment when did. Now how many are getting premium balance due over a year later???
I started work with a new company that uses UHC. I live outside of their main area in the Northeast and when I used their website to look up providers I found none in the area. When I contacted them about this they told me the same thing. I cancelled the coverage and went on the very expensive COBRA plan available due to my old job. My HR department eventually gets to me and after further research finds that a different third-party website shows that I do have providers in my area.
It is unacceptable that their website does not work properly and that their staff is unable to provide the information I need to make my insurance choices. Their misinformation has cost me thousands of dollars, countless hours, and a fair amount of stress all while I've been trying to deal with a serious recent medical issue. If UHC is this terrible at providing simple information, I worry about relying on it for any serious medical issue.