My prescription required pre authorization for the new year. My doctor's office was very quick to react with appropriate documentation. Unfortunately United Healthcare was very incompetent. Making multiple calls (more than 4) and being put on hold for an average of at least 12 minutes per call I finally asked the person ** to pull up the pre-authorization approval and verify that it was correctly submitted. It was then determined that United Healthcare had completely messed it up. They had corrected the verbiage of the message but had "forgot" to change the unit of measure.
I was then told to call back in 2 hours because the department that handled pre-authorizations was not open. It was I, as a consumer, asked that they open the pre-authorization to verify that it it was correctly filled out before one of the 5 representatives I talked to finally opened the document and discovered that my script had not been filled in 4 days due to their own incompetence.
My career has been in analysis and problem resolution and the most basic, first step process is to review the document that is causing the problem. Yet, none of the representatives even though about doing this until I, the customer, recommended that they do this. Even after they finally see what they messed up it will take 3 hours for them to correct it. Sadly, before I made the request for them to open the pre-authorization form all of the representatives were submitting a request for review which would have taken anywhere from 2 to 7 days.
I have already been without the prescribed medication for 4 days. I was looking at potentially another 7 days without medication. It is fortunate that this was not a life threatening medication and in need of quick resolution by such an inept company. I am appalled at such ineptness and disgusted with this service. I now have to drive in an ice storm to pick up a script that is 4 days late due to the incompetence of this company.
SALT LAKE CITY, UTAH -- My doctor requested an MRI authorization from United Healthcare. United Healthcare denied the procedure. BUT, they paid the vendor when they submitted their bill. When I called United Healthcare about the authorization and if I could pay for the procedure myself. I was told by 2 customer service reps that I could submit the bill and I would be compensated. NOT!!
After 2 months of discussion with various customer service reps (every time I called, I had to give all the particulars of the situation as they could not find the info in their system). Each call took about 60 minutes. At this point, I was told that United Healthcare did not make payments to members but had to pay the vendor. When I asked to speak to a supervisor on one of the calls, I had to ask 4 times and get nasty before they transferred me to a supervisor. I was told I could file a grievance and claim.
I received a letter from United Healthcare that they would "discuss" my displeasure with their customer service dept. LOTS GOOD THAT DID I AM SURE. I was told that even though United Healthcare paperwork said the grievance and claim process took 60 days. A customer service supervisor said it wasn't 60 days BUT 60 BUSINESS DAYS. Quite a difference. We have just asked United Healthcare how we would be compensated for emergency services out of country. I was told that I could submit a claim to United Healthcare and they would pay me.
REALLY - United Healthcare wouldn't compensate me for a procedure in the United States and I am to believe they would compensate me out of country??? I would not recommend United Healthcare to anyone and plan to select another medical provider during the current enrollment period.
TENNESSEE -- My father needed to have a CT scan per his doctor to make sure that his cancer (has been cancer free since 2000) had not come back. His claim was denied by United Healthcare. The reason stated was "You have cancer in your nose and throat area. You have neck pain. You have a sore throat and pain in the roof of your mouth. Your provider suspects spread of "cancer" to your brain. Your provider asked for a CT scan of your head/brain with and without a dye called contrast."
The letter goes on to explain what a CT scan is and what a MRI is and then states that "cannot be done for medical reasons and you have a brain function problem such as mental confusion, change in vision, slurred speech or a new severe headache."
My father receives this notification and is devastated!!! First of all, he went the doctor with throat and pain in the roof of his mouth. He NEVER complained of headaches, mental confusion, change in vision or slurred speech. He contacted his doctor and the head nurse called back and apologized over and over again since the information that was sent to him was a LIE!!! She confirmed that no one in the doctor's office provided that information to United Healthcare. It appears that someone that works at United Healthcare falsely added this information/LIES to his records so that the medical services requested would be denied.
I am sure this is not the first time that this has happened to customers of United Healthcare. Please do not use United Healthcare for your medical needs because they falsify medical records so they do not have to approved medical services or items. How many others has this happened to? Who can help with this type of fraud?
SALT LAKE CITY, UTAH -- United Healthcare mailed me five provider appeal requests I never made. I got four in November 2014 and the last one dated December 5, 2014. First one gave the name of a company and said I made a complaint against this place and said they sent a decision explanation and since it was a duplicate, I couldn't appeal it. What complaint and what duplicate complaint? I've never made one. I faxed UHC in November 2014 and informed them that I did not make a report and for them to correct it. Ignoring tactics they use. They sent me four more of the same.
They were dated November 4, 7, 17 and 25, 2014. UHC indicated they put them in my patient ID files. The last one was December 4, 2014 and dated with an individual's name as provider appeal request I never made. I faxed provider complaint on a horrible P.T. records content that UHC had paid for and last phone contact about that was October 27, 2014. Last fax regarding that was November 2, 2014. I never heard back on the issue about P.T. session.
I got harassed by UHC with nut job fake reports instead, gee I wonder why. Also November 3rd and 4th, I got two phone messages to call UHC about another made up nonexistent report. Saw bad scene, I was done with UHC. No more phone contact and I looked for another insurance. I would have had to have made a report and received a letter back on an appealed decision in a specific time frame long before the P.OT.. complaint to have even exist, which it was not.
They have NO phone connection or faxes or letters on fake reports. I got 2 answer machine calls on December 5 and 8, 2014, from service coordinator UHC, phony, prank sounding message telling me to call her about my requesting multiple therapy times. I never did! I stopped all calls. October 27, 2014 was the last and only sent a few faxes November 2014 for UHC to take reports I did not make out of my files. And I did not of course, pursue initial complaint.
I left UHC in December 2014. They also apparently sent me to physical therapy two other times , pulling a stunt of having my significant medical condition completely left out and had my other med files hoaxed with as medical conditions magically deleted. My only opinion is all of the above. I have all of my medical records however. I've been trying to get all the fake files out and straighten the records out through other places, but not able to yet. I have not gotten five fake file reports I never even made. I do not have anything to do with UHC!
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?
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.
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!
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!
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.