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.
TREASURE COAST, FLORIDA -- As some may or may not be aware United Healthcare terminated 70% of the "Network" providers from their panels. Of course as an insured with UHC notification of this action was not given until after "Open Enrollment" ended thereby locking me in another year with UHC, had this information been available before "Open Enrollment" ended I would not be with UHC anymore however UHC carefully navigated the timing of the terminations of the network physicians so as not to become know till it was too late.
My experience began January 21, 2014 my doctor had ordered "fasting" blood work, I called the lab the day before just to be sure I knew where I was going and confirm the hours, of course there was nothing more than a recording providing the address, directions and hours they are open and informing me there would be no live person to speak to at this location (I should have known right then there was a problem). I arrived at the address provided yet there was no sign, no indication a lab was there upon checking with neighboring properties I was told the lab had closed "months ago".
While standing right there I called UHC and after 25 minutes of checking of course I was told the lab was right there. I mailed them a picture of the empty office and then was provided another location to go to have my fasting blood work done without even an apology, I arrive at the next location provide to me by UHC and again the lab had closed months ago, went through the same scenario with UHC and they sent me to a 3rd location where a lab should have been and yes, believe it or not that location had also closed (Lab Corp was now the ONLY network lab for UHC they did not have to be convenient as we have no other choice.)
The fourth location was the charm. I arrived at the fourth location went to the reception desk to sign in on the sign in sheet for everyone that came in to see I had been there (so much for privacy) and was then told by the receptionist I would need to provide my credit card for them to copy and keep on file for any charges to be put on my credit card if not paid by UHC.
Now understand probably 80% of the time a charge is denied or not paid correctly and they would just put through the charge to my credit card leaving me to fight the battle with UHC and that being the least of the problems leaving your credit card on file for any "authorized" or maybe not even authorized person to use. NOT! I will not leave my credit card with anyone for an in case scenario. It is now 12:30 PM and I am still fasting, the room is spinning and I am feeling very light headed and still no blood work done because without my credit card there will be no blood work done.
I finally left went down the street to our community hospital and had the blood work done and did not provide my credit card to be kept on file and we all know UHC is not going to pay them and I am screwed because UHC only allows Lab Corp as a "network" Lab... what other choice did I have? 3 Locations I was provided to go to by UHC turned out to no longer exist and the fourth wanted to keep a copy of my credit card just in case!
No, the nightmare does not end there! I have been under treatment and had a Mohs surgery (for Basal Cell CA) done April 2013 had a couple of complications so January 2014 I was still under care for skin cancers or lesions that left go can become cancer. In December there was another lesion on my back this time I did not know UHC was terminating 70% of the network providers as of January 1, 2014 and my doctor was one of them. I had an appointment the beginning of January so I mentioned it to the doctor his response was "this doesn't look good" so the biopsy was done immediately, it came back a week later.
Melanoma, and surgery needed to be done. It was schedule to be done Feb but 3 days before the surgery UHC canceled the surgery and called to tell me to find someone in "Network." I am distressed as I already am under treatment for Basal Cell and I must go elsewhere but I moved forward as my doctor said I must get this taken care of. I go to the UHC website, put in my zip code and lo and behold, 51 doctors come up but that was not to be so true.
10 of the doctors are listed as many as 5 times with different addresses, 4 of them are more than an hour each way to get to but none had an available appointment until March 26th and it could not be with a doctor it was with a nurse and she would decide when and if I needed an appointment with the doctor (I am not taking the treatment or non treatment of my Melanoma to a nurse!) No wonder they advertise on TV constantly any quality competent physician does not need to advertise on TV for patients! They want to bill my insurance the same amount for a nurse as a physician they are not on the same level as an MD, sorry!
After much back and forth with UHC they found me an appointment with another doctor, I waited patiently for my appointment day, arrived with all my records in hand anxious to finally be seeing a doctor and moving forward with the treatment for the melanoma... NO that did not happen! Though United Healthcare made the appointment and insist this physician was in "network" his office insisted he did not accept my UHC even after speaking with UHC on the phone at length I was left with no treating physician and a melanoma on my back that can be spreading or even moving to other organs and no "Network" physician to see and treat me!
I spent more than 3 hours on the phone again yesterday with UHC and still do not have an appointment for what can be a deadly form of cancer, I am 58 years old there is no excuse, no justification for this to be happening. United Healthcare decided to terminated 70% of the "Network" providers because the fewer providers, the fewer appointments, the fewer appointments, the fewer procedures or surgeries can be done and guess what that all converts to... United Healthcare pays less money and makes larger profits without regard for the health and welfare of those of us locked into UHC until 2015!! This should be criminal.
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!
APPLE VALLEY, CALIFORNIA -- After being told that my mom who has Alzheimer's would have NO premiums (turned out to be a lie as we got a payment book shortly thereafter) and very low co-payments on her meds, etc., and being promised that this company provided much better hospitalization coverage, I agreed to switch my mom from her previous healthcare.
First off, they couldn't get the effective date correct. She signed the paperwork in January 09, and we were told it would be effective March 09. Then the sales representative called me back to say that was a mistake and it would be in effect February 09. Went to get RXs filled in Feb and was told she was still under her old plan, but the co-pays did not match what she had previously been paying. Spent over an hour on the phone with these people, who said her insurance wasn't in effect until March 09. OK, so paid the higher co-pays on her meds.
Waited until March 1 to get an RX filled for her dental appt, and was told it was not covered. Called back to Customer Service on Monday and was told that she was good to go for dentist and RXs (after being switched around the country and talking to at least 6 or 7 reps). My husband called from the dentist's office, livid, because they could not confirm her eligibility.
Oh, and on March 1 we were told that her eligibility was to EXPIRE with NEVERCARE on Feb 29, 09 - THERE WAS NO FEB 29, 09! And why would it expire if it is a new account that had never been in effect yet? My husband tried calling and was told that there were multiple computer screens that had different data in them. Also, they lost the power of attorney that we gave them when we applied for this coverage. Had to send it again - who knows if they have it this time or not.
Then, when I went to get another of her meds refilled, I was told that the co-pay was $122.77 - that for a medicine we had only been paying $3.20 on before. So basically, I am convinced that the sales representative knew absolutely nothing about what she was selling or else was just flat out misrepresenting her product. Either way it is inexcusable to treat seniors with limited incomes like this! I have now switched her to CAREMORE (as fast as I could) and am praying that goes smoother, but still have to live the rest of this month with NEVERCARE and am not sure if they will cover anything at all or not.
I am pretty sure they have NEVER paid a claim on ANYTHING for ANYONE before - that is how it sounds when I am trying to deal with this company. Thought Secure Horizons had a decent reputation, but I guess not this part of the company! Terrible! Terrible! Terrible! Oh, and I can't even e-mail customer service via the web site - no e-mail address is listed! They can rot in you-know-where before I pay any premiums on this garbage! Don't believe their lies!
WEST BLOOMFIELD, MICHIGAN -- I had a wisdom tooth that suddenly decided it wanted to come out and was poking through my gums. I looked online at UHC's list of dentists that supposedly carry my plan, and after 11 phone calls, only one actually accepted my insurance, within 30 miles! And that office told me I would have to have an initial consultation first, then they had to send paperwork in for approval, and that could take 10-14 days. And it will be another week before they can get me in for a consultation. So UHC finds it acceptable for you to wait at least two weeks in a good amount of pain, so they can approve a procedure that very obviously needs to be done.
I tried to contact UHC for help. I called at 9 am ET and the message stated that if I need to speak with someone, I should call back during business hours. But you can't find business hours anywhere on the website or on the message. And how is 9 am not during business hours? And this is just for the dentist! I cannot imagine trusting my health care to these people. Pray that you don't have any emergency that they have to take 2 weeks to discuss.