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, 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.
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.
KATY, TEXAS -- I have had insurance through most major carriers in my 40 years of working and some were good and some left a little to be desired, but United Health Care is undoubtedly the worst insurance company on the market. As with other stories here, they lie, they misrepresent and they deny coverage for coverage they say they in fact do allow for.
I am changing after the first of the year and will never use or recommend this insurance to anybody. My wife is going blind and she needs a medication for her eye (which Aetna when we had them had no problem approving) that UHC will not cover after lying to us and her doctor and saying, "Sure we cover that." It is $200 a week and a medicine she will have to use for a couple of years before she can get a cornea transplant something else they don't cover. All I can say is buyer beware when dealing with these crooks.
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.
CINCINNATI, OHIO -- Recently got notification from United Healthcare insurance that they will no longer cover my son's medication for ADD (Focalin), and did so with about 1 month's notice. I asked my son's pediatrician for a comparable alternative medication and he indicated there isn't one. Paying out of pocket will cost $200/month or more.
It is especially nice that UHC terminated coverage of this and other ADD meds right before school starts because the start of the school year is always particularly difficult for students with ADD. Now many of them will have to tackle it without the medication they need. Seems no one is aware how poorly UHC treats their "customers" until they experience it themselves.
HEALTH INSURANCE, OHIO -- My daughter needed a neurostimulator placement for Occipital and Trigeminal Neuralgia. The surgery was scheduled for April 2014. The doctor's office sent all info to UHC for approval. The approval was received, dated 3/5/14. Unfortunately, the doctor had a family emergency out of the country and the surgery had to be cancelled. When he returned, the surgery was rescheduled for July 2014.
6 days prior to surgery, we received a call stating that UHC denied the surgery. Why? Pick a reason! "Not a covered benefit", "no medical evidence to support the procedure", or "waiting on a peer-to-peer review". Some physician, sitting in his "Internal Medicine" office in Illinois, decided that my daughter, who has about 10% quality of life at this point, did not need this! A neurosurgeon, after an extended consult, decided she DID need it, but this doctor who had never met her decided NO!!!
For as long as both Hubby and I have had full time jobs with benefits, we have almost always elected to use my husband's benefits for medical and dental insurance (mainly because I liked their medical insurance more than mine). We would reevaluate this every November when our respective employers' open enrollment period would begin. It's a system that has worked well for us as the coverage has almost always been comparable between our two workplaces.
Last November, when my job's open enrollment was announced, I asked my husband if he had heard anything from his job about OE. He hadn't so I held off on making any changes until close to the end of my enrollment period when I asked him again about it. He said that they had told him that they wouldn't have any information for a few more weeks but as far as he knew, there hadn't been any talk that year about changing providers (it had been a concern in past years as Blue Cross was trying to jack up the prices as usual).
Assuming that things were going to be status quo, I made no changes to my employee benefits aside from adding ** to my list of dependents for life insurance and vision insurance (I always carried the vision since his job didn't have any at the time). Two weeks after my job's OE period ended, my husband called me at work to tell me that his job was switching both the Medical and Dental benefits to UnitedHealthcare.
Since they had ** footed around and waited until the second week in December to make this announcement, we were SOL. Fortunately all of our physicians were in-network, so that didn't have to change. As far as dental insurance was concerned, I didn't really have any problem with whatever they offered since we had never used the dental benefits no matter who carried them. We just had it as a "just in case."
This spring, we found out that ** has cavities. A lot of them. And they're going to require a lot of work beyond the usual fillings (long story, not going into that). Anyway, we got an estimate from the dentist and I noticed that what was actually listed as the patient's responsibility (about $900 out of the nearly $5K total bill) was much less than what they had told me would be my portion (they told me over the phone that I would be responsible for about $3200 of this bill).
I looked at the benefits sheet for our dental insurance and I saw the line that said "Annual Benefit Maximum" was only $1000. I called UnitedHealthcare (their people are very polite, I'll give them that) and they confirmed that they will only pay about $1000 per year per person. What good is that when you're looking at work like this? It was bad enough that I had to search high and low for a pediatric dentist that was "in network" because the insurance would pay nothing for an out of network dentist, but now the most they'll pay is $1000?
I thought maybe this was par for the course for all dental insurances (they want prevention and early intervention rather than waiting until something like this happens, I'm sure), but then I looked over the benefits that my employer's dental insurance provided (MetLife), their annual max was $3000! There's plenty of blame to go around here. We shouldn't have waited so long to take ** to the dentist. But I blame my husband's job for waiting so long to let their workers know that their benefits would be changing (had we known that they were switching providers, I would have gotten on my insurance even before I knew the specifics).
I blame the HR lady for convincing my husband to take the lower dental insurance that pays nothing for out of network (I wanted the better paying one that would have paid almost same for out of network as in network) even though that wouldn't have helped the benefit max (same for both plans). And I blame UnitedHealthcare for giving us such useless dental insurance for almost the same cost as I would have paid for the better coverage through my employer!