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.
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.
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?
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.
SALT LAKE CITY, NEVADA -- I was hospitalized in May of 2015. I first went to urgent care and was transported from that facility, by ambulance, to the emergency room. I was diagnosed with pneumonia, sepsis and was in renal and respiratory failure when I arrived. I was intubated and put on a ventilator and spent 8 days in ICU. The policy I had, had a $5000 deductible and a $6250 out of pocket maximum. I have satisfied the out of pocket max but I am still having problems getting UHC to pay the physician claims.
On my first appeal, they responded that they had not received the H&P and other medical records to support the claim. I responded with another letter and included all the clinical notes from each day in ICU. I then received a response with another denial saying that they could not find a claim for this appeal. The provider listed on the second denial was my new insurance carrier which was not effective until 11/1/15 and was never mentioned in any of my letters. The letter also stated that I had exhausted my limited appeals.
I responded with a third letter, highlighting all the information and I insisted that a supervisor look through all the documents and respond back to me by phone. I am giving them one week to respond and then I will go the state regulators. I have all the documentation and I am sure in the end they will have to pay the claim. I have never experienced such incompetency and poor customer service in my entire life.
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.