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 ledgible 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!
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, Olivia, has moderate cerebral palsy. She is lively, fun, and most of the time, does not believe that she is different from anyone else. Olivia 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, Olivia's tightening of her leg muscles began to affect the growth of her bones. Without proper surgical intervention, Olivia 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 Olivia'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 Olivia'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.
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. Olivia made wonderful progress... working really hard!
The trouble began when UHC's policy said Olivia 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. Olivia'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, Olivia'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 Olivia 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: Olivia 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.
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...
TEMPE, ARIZONA -- Tried to refill prescription for generic actonel. In the past I was allowed 3 months each time.
I was told:
a) could not submit until 4 days before the medication was due
b) unclear whether I could get 3 pills or only 1 pill.
Given work and travel it is difficult to only have 4 days notice to refill. This definitely risks missing a medication dose on a medication that is supposed to have precise dosing.
Had previous bad experiences with diagnostic tests being held up.
Will drop them as my insurance company at the next opportunity and recommend that no one else chooses them because they definitely risk their customers' health and have no concern at all about it.
NORTHRIDGE, CALIFORNIA -- When signing up of this group, I was told that my first appointment would be within two weeks at the latest. My policy started Feb.1 and the office was closed so I called the following Monday and I started to make my appointment but they said they had too many calls and they would call me back in 20 min. Well, 45 min later I called them back. I asked for the earliest appointment and they said it would be 1 ½ months from today. When I asked for another doctor they gave me even longer times and tried to push a residence Dr. (Doctor in training) on me. I made the appointment for 1 ½ months out and asked for a physical but they said "Cannot do" the first appointment is only to get to know the Doctor. Looks like my first physical will be two to three months out. This is just a terrible health care practice. So far this United Healthcare in Northridge, CA sucks.
FORT COLLINS, COLORADO -- They lie about referrals and deny coverage . they are the very worst health providers in the entire USA. They should be put out of business. you have to call their customer service people 10-20 times and get a different story every time. All the doctors and hospitals hate them for their very poor service. When is it going to be that they are put out of business. They refuse to provide the service that is promised in their contract. And they lie about referrals being good. You go get your medical service done. And then they send you letters saying that the referral was not any good and then want you to pay the total cost out of your pocket.
The people of the USA need to shut this company down and fine them as well as file federal charges for false insurance practices.