ATLANTA, GEORGIA -- Since becoming a member of United Healthcare about 31/2 months, I have been denied, or put through the authorization process, about 5 times, medication that my previous Insurer has paid for, without question. They farm out prescription services to Medco. I have followed their procedures, and still they make me change to a cheaper medication, even though my doctor thinks he is prescribing what is best for me. Their job is to "be the judge" of what you get. If your plan does not cover what your doctor thinks is best for you, you and your doctor have to follow an appeal process.
They will spend hours and hours on the phone, and still keep a patient from getting something they don't want to pay for. They will send you an authorization, or an appeal form, but by this time, you have already left your doctor's office, and are waiting. Sometimes you can get your meds, and sometimes you just have to deal with it. If they are so worried about their bottom line, they should be cutting better deals with the pharmaceuticals, but they already do that, don't' they? Or maybe raise their rates. Oh, yes, they have done that too. They even want me use a pill cutter to cut my one med in half, just so they don't have to buy both dosages.
Since most of the competing healthcare insurance companies been gobbled up by Aetna, United and others, their simply is not as much choice for employers to shop around for quality, affordable plans for their employees. Period. If members of the U.S. Congress had to deal with a fraction of this hassle, they would be changing the law in a New York minute! Keeping people out of the hospitals by the use of drugs already is a proven approach for everyone. They do not even have a form, that I can find, that includes a space to enter a date, service, doctor, or billing code, so you can use it to get reimbursement, without having a doctor bill with what they want on it.
This is not practical for the insured, at all. Why keep that service or medication from us, so that we get sicker, and risk an even bigger claim? The answer is that they know we have no one in our corner, as they do in Washington. I urge people with issues of abuse of power, and denial of service to let their thoughts be known, or it will never change. I also urge anyone who is trying to buy health care insurance, to find out all the details you can before you sign up, because after that, it's too late.
I have been getting the runaround from this "company" for OVER 4 months. That has paid out BILLIONS of dollars in lawsuits (last one was $594Million). That if they would use 1/2 of that towards us folk that pay in $$$ for denial of service. Maybe we could GET our preexisting meds!!! Or you can file an appeal (not done by a Doctor), then you can do a 2nd appeal after they shoot you down the first time. And DON"T bother asking for "copies of all documentation that was used to come to our decision".
Cos then you get sent 2 or 3 letters sending you every thing you DIDN"T ask for. (lets waste 4 more months of my time),especially when I sent the last letter with, CC: Tx. Dept of Insurance on the bottom, to file complaint with them Then I got a complaint form from UHC hoping I'd go for a Civil case. I am a recovering alcoholic of 18 months as of yesterday.
Before my boss switched Ins. Co.'s, all was well and covered.After getting out of 6 days inpatient detox and 12 weeks (3hrs a day 4 days a week). My Psychopharmacolagist prescribed me an injection called Vivitrol. It blocks the receptors in my brain, thus elimination the alcoholic cravings and if I were to "back slide" and drink I would feel NO affect from the alcohol. Aetna (old ins. co.) covered on it the 1st prescription my Dr. wrote. Within 3 days the effects shocked me. I DID NOT crave alcohol for the first time in YEARS (I was drinking a fifth a DAY)! Then my boss switched to UHC.
When I went to pick up my monthy Vivitrol to get my injection, I was informed that I need to pay my FULL $1500.00 deductible to receive 1 injection (The drugs cost through Alcomeirs(sp) Co. (that makes the drug ) is $885.00. In my pamphlet from UHC it states "injections need to be administered by a Physician is excluded EXCEPT for DeproProvera, a form of birth control that is placed under the skin and left there. My Vivitrol is a simple injection. THEN in the same paragraph it state "this EXCLUDES pharmaceuticals that can be obtained by Dr.'s prescription and picked up at a pharmacy.
"Well, my Psychopharmacologist Prescribed it 18 months ago,he write my monthly prescriptions and I pick them up at CVS Pharmacy. SO... Contradiction of statements in the same paragraph. Question to all... would you rather ride around with a pregnant person,or someone that's DRUNK?? And if this drug can prevent that, it's got my vote!
If I as a single 53yr. old w/ no children or family, HAD $1500.00 to spare, I WOULD get my medication and deal with the rest later. It's just UHC's runaround tactics are total BS. And hopefully if nothing else (there is a class action suit just for this exact tactic) Texas Department of Insurance will look into this matter. Thanks for listening, sorry I wasn't clearer earlier. Just SO frustrated!! Happy Labor Day all!!
TENNESSEE -- I am a in network provider for United Healthcare, for now. UHC goes out of their way to avoid payment to providers by demanding clinical notes and records with no reason at all but to put up clerical roadblocks. I received denials asking for the patient notes because "information on the claim submitted is either missing, not legible or incorrect". When I called and asked what information is missing or wrong they can not answer. When the reason for requesting the notes for a patient is invalid, why are the notes still required for payment to be made? They also ask for Clinical Submissions to be sent in to ACN Group (owned and operated by United Healthcare) for approval.
Sometimes it is required and sometimes not. However on my last 6 UHC patients who did not require Clinical Submission, all of the claims for these patients were denied because clinical submission was required. When I called to find where the problem is, they apologize and state they made a mistake (actually dozens) and resubmit the claims only for me to receive denials again for the same reason.
Finally I found that Clinical Submission was required for all 6 patients and now are refusing to pay because of their error. I have many UHC patients that will be effected by me getting out of network but I refuse to continue to do business with such an unethical company and am filing a complaint against UHC with the Insurance commission in Tennessee.
I sincerely hope all providers who are in network with UHC does the same if for no other reason but to make them answer for their behavior. PLEASE, if you have an option for which Insurance provider you use, chose ANYONE but United Healthcare. Don't make your Doctor go through what I have. You and your provider deserve better!
MISSOURI -- Good Day. In light of recent coverage in the media regarding healthcare and insurance companies, I thought our situation may be of some interest. Mostly, as a concerned parent, and registered nurse, I think it is important that all consumers be aware that an insurance company does not have to provide standard of care for its subscribers. I considered myself fairly knowledgeable, yet we are still facing a less than expected outcome for our daughter.
Our 9-year old daughter, **, has moderate cerebral palsy. She is lively, fun, and most of the time, does not believe that she is different from anyone else. ** is ambulatory and has been relatively healthy. She enjoys activities that her peers do, including dancing, PE, gymnastics, and swimming. We are so blessed to have her in our lives. Like many children with ambulatory spastic diplegia, **'s tightening of her leg muscles began to affect the growth of her bones. Without proper surgical intervention, ** may very well have lost the ability to walk and run in her future.
After much consideration, we consented to our surgeon's proposed solution: bilateral femoral osteotomy. In English: both of **'s thigh bones would be broken in two, repositioned, plated/screwed back together, and muscles manipulated. The goal of this surgery is to improve positioning of a person's muscles and legs to improve gait and promote healthy bone maturation.
Since this surgery is standard medical care for the external rotation of **'s legs, we did not anticipate any difficulties with our insurance coverage. Our physician office notified United Health Care of the intended surgical plans. I, too, called to verify coverage and notify them of the plans. We received, in writing, that UHC was aware of the surgery and it was a covered benefit for **.
Olivia had surgery March 30, 2007 at St. John's. She did well post-operatively. She left the hospital as planned and went home to recuperate. Physical Therapy Rehabilitation is critical to the success of this procedure. We began as prescribed. ** made wonderful progress... working really hard!
The trouble began when UHC's policy said ** could only have 20 PT visits; she really needed more like 80 visits. Other folks have had similar situations, and with the proper documentation, exceptions have been made. (I personally know a child who had the same surgery, also has UHC with the same contracted 20 PT visits per year, but was given 100 for the first year, and able to increase if needed!)
Olivia should have been going to PT 3 times per week, intensively, and been finished with rehab in 6 months. She did her home program faithfully and we thought all was going to turn out well. But United Health Care denied our request for review-- FOUR TIMES. Sending the same form letter repeatedly. **'s physician and his staff attempted to call, asking for "peer review" of the case, as we were advised to do by an UHC employee. They were put on hold for hours at a time, as was I. No answer other than the form letter was ever provided. Our physician was not allowed to speak with another physician regarding the standard of care for this procedure.
Healthcare really does need reform. Admittedly, so many folks have abused the system, especially concerning out-patient therapies. As a nurse, I have witnessed this first hand. Often, **'s diagnosis of cerebral palsy sets off alarm bells. We were not expecting her to receive care that was above and beyond what was needed to make her as strong as she was before surgery. But since we had to private pay for physical therapy, even with financial assistance from St. John's, she did not receive what she needed. She is still in rehab, we are still private paying for her care the best that we can, and she is not back to her pre-surgical abilities.
As I face the prospect of her potential future, I am afraid. She will need surgery in the near future to remove the hardware placed during her March surgery. Will she ever regain her strength? We cannot afford (financially and otherwise) to let ** down. She is a remarkable girl, full of spirit and ambition. She dreams of being a pediatrician that helps other children with cerebral palsy. To be frank: ** was treated unfairly, perhaps even discriminated against because of her medical condition. Parents, and consumers need to be aware that insurance companies are not required to provide the standard of care. **
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 phycians 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.
NORTH CAROLINA -- I have United Healthcare Medical Insurance and I live in an area of NC where roughly 80% of all medical providers are associated with Carolinas Healthcare Systems. United Healthcare did not renew their contract with CHS and I realize that both parties are at fault for letting negotiations fail, but we PAY UHC for their coverage so I think they owe us a little consideration when deciding not to do business with the company that provides the vast amount of care in our area. All of UHC's customers in our area (about 80,000 people) now have to find all new doctors.
For me that means new Gen. Practice physicians for myself and my spouse as well as new pediatricians, new dermatologist, new OB, new Orthopedic, new neurologist, etc. etc. The list goes ON and ON. The kicker is that we can no longer even go to Urgent Care in my area. So if my child gets sick or hurt over the weekend I have to drive him 2 towns over or into South Carolina for help. That's right, I'd have to drag a sick or hurt child into another town or possibly another STATE. That's the kind of care you get from United Healthcare, so beware.
KANSAS CITY, MISSOURI -- Since I became self-employed on 2013, I've been using United Healthcare. I thought this is the only one available for Individual Coverage. I have a balance in my deductible in 2013 and in 2014. But both years, I received an increase in my premium. The increase was timed when the open enrollment is already closed. That is not good business practice. I wasn't happy for getting a $90 increase last year.
This year for 2015 coverage, my premium is raised from $386 to $452 for an individual. I don't have a family and it's ridiculous to pay $452 per month. I got the letter when the open enrollment is no longer available. I understand that there will be increases but they should do that during the open enrollment so people has a choice to continue or find another provider. The moment I can, I will move to a new provider and I will advise anyone I know who's using United Healthcare to change provider.
IRVINE, CALIFORNIA -- I have tried repeatedly to get my scripts refilled for Accu Chek glucose meter strips. I was informed that they, Optumrx, are only allowing me 50 scripts
every 3 weeks when I have been getting 200 a month. I am a INSULIN dependent type 2 diabetic and need to test more often than a non insulin use patient. This is not something that just changed since I have had this for over a decade. Besides "why would Optumrx deny me the glucose strips but allow the Insulin syringes to be filled if they thought I was a non insulin using patient?" Funny but UHC just changed the way they do things and now the patients are the one to suffer because their Representatives lack the ability to read medical information that is at their finger tips.
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.
PERSONAL ...NOT BUSINESS, RHODE ISLAND -- Had ears evaluated and found a hearing aid was needed..called the only one in network..called them only to find they had no office in state... they proposed to fill my prescription that I would Fax to them and mail aid to me.
I did not want that I wanted someone I could get help from if I needed help and I could not understand how one gets volume adjusted when we are in different states. After speaking to a supervisor for some time she gave me permission..I asked for written copy of decision she didn't think necessary as she would put directly on my file...guess it was necessary as United has denied I called.. said not on file.. and they will not cover..
I have given name of supervisor I spoke with..the number of notation of call..they maintain I didn't call yet I have been told by two reps that it is in my file..this started in Nov.' 13 still no paper work I need to take next step..Guess I will have to get Lawyer.....not a good company to do business...