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Insurance Terminated
Posted by on
I'm not one to air out my life issues. However, a story needs to be told. I was diagnosed with Breast Cancer two and half years ago. Since my chemo, surgery and radiation - I have been in remission. So, call me a survivor if you will.

The one thing I haven't managed to survive is the fear of Medical insurance. When I was diagnosed I worked for a Bank and had wonderful insurance. We all know what happened to some of the banks - I lost my job in the middle of treatment. However, my employer and insurance provider stuck by me and I will never have one bad word to say about them.

Shortly, after my battle I was able to find a job and stayed on Cobra until I was able to get onto my new employers policy. The first six months were great, never worried, provided them with my previous insurance information and they paid all of my bills. Then my employer changed carriers four months ago and I just received a notice in the mail yesterday that my insurance had been terminated due to pre-existing condition.

I've never had one day laps of insurance since my diagnosis. I've paid all of my payment and copays etc.

I haven't contacted UHC yet, I will do so tomorrow. The thing is I've been going to my yearly followup appointments in the past few weeks and had I known my insurance had been terminated well, I wouldn't have racked up a hefty $5,000 in bills that I now must figure out how to pay.

The kicker, I made it a point to call an Attorney before I gave up my Cobra Insurance to go with my current employers. I was advised that they cannot consider my condition pre-existing unless I had a gap of insurance and he told me to never have one day without insurance, and I've done just that.

It's not fair for Insurance Companies to punish people in this situation. I never asked for Cancer - and now that it's out of my body - I feel like I'm dealing with a whole different form of Cancer - It's called BULLCRAP Insurance Companies. If I didn't need you so much - I'd tell you to go ****off
     
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Anonymous on 12/13/2009:
This situation is horrifying. I wish the best for you and I wish I had an answer.


NofriendofAX on 12/13/2009:
I know, thank you so much for your concerns. Let's hope I can make some headway with this stupid insurance company. If I cannot, well you'll probably see another posting on here for me soon! The next one won't be as pretty
Hugh_Jorgen on 12/13/2009:
Sounds like it's time to get your state's insurance commissioner's office involved. Sounds like you followed all the rules. Best of luck!
Anonymous on 12/13/2009:
What Hugh said. Good luck.
Anonymous on 12/13/2009:
It embarrasses me to say that I work in an industry that does this. I'm sorry that I do not know of the legalities surrounding pre-existing conditions and you shouldn't have to look for loop holes. Follow Hugh's advice and DON'T give up. Please come back and let us know what happens.
NofriendofAX on 12/13/2009:
Yeah a good friend mentioned getting the State's Insurance Commissioner involved. I'm going to give my Insurance company one chance to explain. If not luck I'm calling the Commissioner next. Thanks for the information!!!!
Class Advocate on 12/13/2009:
Do not take the following as legal advice or as gospel.

The operative federal law that applies to your situation (I think) is the Health Insurance Portability and Accountability Act (HIPAA). (Your situation is a bit different as it is a group insurance company taking over an existing plan as opposed to the more traditional situation where a new employee seeks coverage under her new employer's existing plan).

HIPAA does allow an insurance company to deny coverage for a pre-existing condition for up to the first 12 months of new coverage. However, that 12 month period is reduced by the amount of "credible coverage" you have had in the immediate past. If as you say, you have had uninterrupted coverage since diagnosis, then perhaps the 12 month period should be reduced to 0 and coverage is warranted.

HIPAA is a complement to your state law, so your rights might be greater under your specific state law.

Without knowing all the facts then you should definitely get all your paperwork together so you can prove that you have had uninterrupted insurance coverage since your original diagnosis. This is key!

I found this link to the Department of Labor web site. It does a pretty good job (better than I) of explaining the above.

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

Good luck.
Suusan B. on 12/13/2009:
I just went off COBRA and joined my new employer's group health insurance plan. I received my "Statement of HIPPA Portability Rights" statement from the previous carrier. It specifically states, "If a plan imposes a pre-existing exclusion, the length of the exclusion must be reduced by the amount of your prior credible coverage. Most health coverage is credible coverage, including group health plan coverage..... You can add up any credible coverage you have, including the coverage shown on this certificate, if at any time you went for 63 days or more without any coverage (called a break in coverage) a plan may not have to count the coverage you had before the break". You state you never went without insurance (most likely paying huge dollars for COBRA)therefore did not have a break in coverage so your pre-existing condition should not be a reason to cancel your insurance. Remember, just because an insurance company cancels your coverage it doesn't mean that they have the right to do so or are doing so within HIPPA regulations. Get an attorney and fight. Best of luck to you and hopefully your former health issues are behind you forever.
voiceoff on 01/06/2010:
Congrats on being in remission. The treatments you took were beneficial and needed and they denied them only because they were so expensive. It is so wrong to have a person who has fought a serious illness to now fight to have care without the fear of losing all savings. We are a nation who has been given so much we need to have compassion more than money. Look at 911. Can't we be human instaed of just looking at bottom buck?
PLease let us know if there is a positive end.
Anonymous on 01/06/2010:
If your company is changing carriers, do you have to change too? Or can you not just continue with your current coverage as an independent policy holder? Or do you have to be part of the group thing?
kristj96 on 07/07/2010:
I happen to work for a insurance company the handles large companies.. small companies and even the self employed.. I deal with the members directly and on a daily basis.. I can tell you that when a policy is cancelled w, hile employed under a large company it is because the employer group cancelled the policy, this can be fixed by contacting your hr... I am sorry about what you are going through and it is horrible, but keep in mind you don't pay the insurance those premiums every month you are repaying your employer. They have already purchased the policy from the insurance company,,, if your hr is telling you there is nothing they can do it is because if they are self funded they don't want to pay those bills...because with self funded plans the insurance company is paying those bills from a bank that is set up by the employer,,, if they are fully insured they... actually purchased the policy hope this helps... not only with HIPAA you should need to worry about pre existing coming to play... this is something you need to bring to the attention of your hr
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United HealthCare Medco- Denial, or Delay of Coverage
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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...
     
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goduke on 11/17/2009:
The formulary in your plan was agreed to by your employer. They did that to achieve a certain cost point. Medco is only enforcing the plan which your employer is paying for. You have the option to pay out of pocket for any prescription. You are not forced to use insurance.

Many americans think they should have insurance which has low cost, low premiums, low copays and unlimited coverage. That's just not realistic. At all.
BEJ on 11/17/2009:
Your employer picked this plan to offer you. They usually pick what is cheapest for them. It has nothing really to do with the insurance company--they approve/deny based on plan provisions set out in the contract. You want better insurance--contact your employer they hold the key. I am willing to bet most folks would be willing to pay a bit extra for a better medical plan.
Anonymous on 11/17/2009:
Spend your own money for your drug needs and you won't be denied.
Doctor Charlie on 11/17/2009:
Your employer sets up the formulary. Why is your doctor prescribing you such expensive medications? What are some examples of medications that have been denied?
MSCANTBEWRONG on 11/18/2009:
Can you switch to a generic drug? They most likely will pay for those.
JR in Orlando on 11/18/2009:
You needing medicine is your responsibility. The contract for insurance provides certain benefits. If you want more coverage for medications, buy it or pay for the medications itself. This is like arguing at a concert that your general admission tickets entitles to you sit in the front row for the same price.

Either get your doctor to prescribe something covered by the policy or pay the difference. There is nothing the insurance company has done wrong, by sticking to the terms of the policy.
cmyers900 on 03/24/2011:
I love all the comments from people who must obviously have the best health care coverage, probably don't pay for it and can tell others how they should or should not go about getting drugs or other means of healthcare. Until you walk in someone else's shoes how dare any one feel someone should have to go without or pay for something that is not within their means. Let's hope one of your loved ones never run into any issues. Let's have the tables turned then and see how you feel. I am a firm believer in Karma.
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United Health I don't care Ins.
Posted by on
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 denile 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 bottem, 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 yesterdayBefore 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 phamhlet from UHC it states "injections need to be administered by a Physician isexcluded EXCEPT for DeproProvera,a for of bith control that is placed under the skin and left there,my Vivitrol I sa simple injection.THEN in the same paragraph it state "this EXCLUDES pharmacuticals 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.Its just UHC's runaround tactics are total BS.And hopfully 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!! =]
     
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Skye on 09/04/2009:
What are you talking about, getting pre-existing meds? Not sure what your complaint is about.
jktshff1 on 09/04/2009:
The only pre-existing meds I know of are natural ones LOL.
Pre-existing before what?
DebtorBasher on 09/04/2009:
The only people who ever sees any money from class action suits are the lawyers. If you think HC wasted four months of your time, a class action suit will only add to your time wasted.
andbran on 09/04/2009:
the company I work for uses United Healthcare. I have never had any problems with them. they pay my doctors and meds with any hassels
andbran on 09/04/2009:
I meant to say without any hassels
kristj96 on 07/07/2010:
you might want to check the plan sounds like you have a combined medical/prescription plan... which if that is the case it is not the insurance companies fault it is your employer who changed the type of plan you have... sometimes people really need to learn to read the plans before selecting them that is why you have open enrollment... always selecting the cheapest plan your company offers doesn't always pan out the way you hoped it would
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The Worst Insurance Company-Providers/Insured beware
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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!
     
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Standard of Care
Posted by on
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, 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.

Kelly Apollo



     
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Anonymous on 12/11/2007:
I would like to compliment you on your positive attitude in a really lousy situation. Persevere, don't let them off easily. You might want to consider contacting the insurance commissioner in your state. Good luck.
Anonymous on 12/11/2007:
hi kelly. I notice you are in MO. You might already know this but because your daughter has a developmental disability she qualifies for assistance through the Missouri Department of Mental Health. They pay for things like therapy, equipment etc and it is not based on income. Please if you aren't already enrolled check out:

http://www.dmh.missouri.gov/mrdd/help/faqs.htm#eligible

It explains the programs and how you qualify. It takes persistence so please don't let them put you off, hang in there and get what you need for your daughter. There are also Senate Bill 40 boards in St. Louis city, county and St. Charles county that fund items (with tax dollars, also not based on income)for people with developmental disabilities and are wonderful resources. Not sure where you are but here is the number of one, they can refer you to a Board in another county if you need it: DDRB of St. Charles County 636-939-3351 or www.ddrb.org
There is assistance out there, not enough of course and you have to jump through hoops to get it but it is there. Good luck to you, sorry this is so long!
Anonymous on 12/11/2007:
Kasa, you are truly an inspiration with your positive attitude and I hope nothing but the best for you and your daughter.

You should check out what amaniR is saying because she is one of the most caring and compassionate people on here and she knows what she is saying.

I will be praying for you and yours.
Anonymous on 12/11/2007:
Kasa, agree with Lidman 100%! Wishing you the very best.
jenjenn on 12/11/2007:
This situation is very delicate, and I applaud you for seeking the best medical care for your daughter. Unfortunately if your health plan states only 20 PT visits, they will not make exceptions for additional visits, if needed. The plans are written & implemented as they are written. Good luck with your situation.
steve101 on 12/11/2007:
A very unfortunate situation. There has to be a compassionate physical therapist in your area who will work with you regarding finances.
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RX Coverage
Posted by on
Rating: 1/51
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.
     
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Denial, 4 Months After Approval
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Rating: 1/51
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!!!
     
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Have Received O.K For Out Of Network Use...Will Not Cover
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Rating: 1/51
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...
     
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United Health Care Insurance creates so many barriers that they make it likely that your medication will be unavailable. They do n
Posted by on
Rating: 1/51
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.
     
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First Appointment Is Over 1 Month Out.
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Rating: 1/51
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.
     
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