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United HealthCare Medco- Denial, or Delay of Coverage
Posted by Mark63 on 11/17/2009
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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Posted by goduke on 2009-11-17:
The formulary in your plan was agreed to by your employer. They did that to acheive 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.
Posted by BEJ on 2009-11-17:
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.
Posted by Anonymous on 2009-11-17:
Spend your own money for your drug needs and you won't be denied.
Posted by Doctor Charlie on 2009-11-17:
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?
Posted by MSCANTBEWRONG on 2009-11-18:
Can you switch to a generic drug? They most likely will pay for those.
Posted by JR in Orlando on 2009-11-18:
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.
Posted by cmyers900 on 2011-03-24:
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 some one 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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Unwilling To Help Solve Problems With Out Of Network Providers
Posted by Antonina on 10/01/2008
PALATKA, FLORIDA -- United Health Care is THE worst insurance company there is. If there is another I pray I never have to deal with them. They refuse to grant me another year of an accommodation for out of network physician I have been seeing for 10 years. They did so last year but this year are giving me the run around, not that they didn't last year but I got the accommodation. Don't lay down like a door mat, fight them through your Human Resources department and if they won't help go to the corporations HR department.

You MUST stand up to them It's frustrating but the squeaky wheel does get attention!!!
     
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Posted by jenjenn on 2008-10-01:
Are there providers within the network that can see you?
Posted by chris513 on 2008-10-01:
no
Posted by Anonymous on 2008-10-01:
Are you on the Basic health plan or the Plus plan?
Posted by chris513 on 2008-10-01:
Basic
Posted by Anonymous on 2008-10-01:
not you, the OP.
Posted by chris513 on 2008-10-01:
don't be a pigeon, JC.
Posted by Anonymous on 2008-10-01:
whatever chris
Posted by chris513 on 2008-10-01:
i was just sayin...
Posted by Principissa on 2008-10-01:
It would be easier if you chose an in-network provider. If you really like this doctor and they are not in network, why bother with insurance? I know our insurance only pays for 15% of the visit anyway. Way I see it, just pay the whole thing out of pocket and leave the insurance company out of it.
Posted by Anonymous on 2008-10-01:
That's why I asked if they are on the Basic or Plus plan, Princi..it definitley is easier to have an in-network provider, but I have United Health too, and on the Plus plan, if your medical provider is out of network, UH still covers 80%.
Posted by Anonymous on 2008-10-01:
justcuz--I have the plus plan, but I think I have to fulfill a deductible before they kick in the 80% for out-of-network. I, too, have had to fight UHC over claims that were in-network and should have been paid 100%. After numerous phone calls, they finally did pay up. They do seem to have gone downhill over the years, but, unfortunately, so have a lot of insurance companies.
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They are the worst
Posted by Jeeves on 01/29/2008
This company may save your company money but I would avoid them like the plague if you have any choice in the matter. In my area of North Carolina, they refuse to pay for any services provided by Wake Medical Centers which has been a real blow to many in the area whose doctors work out of Wake Med. Not only that but every doctors office I go to rolls their eyes when I mention the name of this company. I've been told by those in the doctor's offices that United Health will withhold payment for as long as possible. My own experience- they denied a claim as a "pre-existing condition" automatically in violation of the HIPAA laws. Of course, once we called they said they would resubmit but this is just part of their "modus operandi". They hope the patient will just pay the bill without question or at least they'll get to hold on to the money for an extra month or so by denying it the first go round.

It's companies like United Health that are going to lead to the revolution in this country as people say "I'm mad as hell and I'm not going to take it anymore."
     
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Posted by Anonymous on 2008-01-29:
I guess my question is, "Is there a good health insurance company out there right now?"
Posted by Anonymous on 2008-01-29:
Yes but you have to live in Norway.
Posted by Suusan B. on 2008-01-29:
I'm insured by UHC and have recently racked up huge charges in connection with what at first was a simple dislocated shoulder due to a fall but ended up requiring 2-1/2 hours of surgery. So far they have promptly paid everything. Other than the two ER visits, I was very careful to make sure that procedures, equipment, etc. were approved by UHC before proceeding.
Posted by tnchuck100 on 2008-01-29:
I, too, am insured with UHC. So far they have been prompt in paying the bills that have been submitted. Just as in Susan's case, I verify with each service provider that they, do, in fact, accept UHC. You must be diligent in this respect.

The only negative experience I have had is when I advised them they were being billed for a service that was not provided. They seemed totally disinterested that I was reporting this error.
Posted by jenjenn on 2008-01-29:
Providers have a choice to be part of an insurance network. A lot of them are getting really GREEDY (I'm talking providers here) and refusing contracts because they think they're not getting paid enough.
Posted by Suusan B. on 2008-01-29:
UHC (and other carriers) enter into agreements with doctors and medical facilities and it sounds like the management at Wake Medical Centers have elected not to accept payment from UHC. Therefore, that portion of this complaint should be directed to the medical facility, not UHC.
Posted by Anonymous on 2008-01-29:
HIPAA deals with privacy issues. In "your experience" how is a denial of a claim a HIPAA violation?
Posted by Anonymous on 2008-01-29:
Ken -- Not true. Most of HIPAA has nothing to do with privacy issues. In fact part of title 1 of HIPAA deals with pre-existing conditions and insurance companies just as the OP stated.
Posted by Anonymous on 2008-01-29:
HIPAA also provides some wonderful marijuana for people that need it medically. Bet you guys weren't aware of that. It is highly concentrated. I guess you could say it makes Hipaa-pot-a-must.
Posted by Anonymous on 2008-01-29:
I think I need some sleep.
Posted by Principissa on 2008-01-29:
Stew is correct on Title 1. Title one basically says that they cannot create eligibility rules and change premiums based on preexisting conditions. However, it does not apply to private insurance. It also limits restrictions that a group health plan can place on benefits for a preexisting condition. But they can refuse benefits on a preexisting condition 12 months after enrollment or 18 months after late enrollment. So now my question is how long was the poster enrolled before they decided to deny coverage of this preexisting condition? Unfortunately they did not violate HIPAA guidelines if they are within the definition of Title 1. And if they were it is going to be very hard for you, the patient to prove otherwise.
Posted by *Brenda* on 2008-01-29:
I have United Healthcare and the only problem I've had is with a lab test they didn't pay right away. I paid the bill but they eventually did pay it (after 3 months) and I got a refund from the lab. Doctors have been paid quickly.
Posted by jktshff1 on 2008-01-29:
Sounds like the Dr's office has a complaint with them. I'm sure that they have an agreement with UH in some sort of written form. If they accept the insurance, collection from the company, should be their responsibility to collect. Unfortunately most Dr's have an "escape clause" that if the insurance doesn't pay, you have to. I can see their point, kinda like a CYA clause.
It's a win/win for the Dr and insurer and as usual the consumer gets the loss.
Posted by rubberbarron on 2008-10-17:
I totally agree. My specialist refused to accept United Healthcare because they make it especially difficult to collect claims. They also have some terrible doctors in their network, including Dr. Sidhu, who almost killed me through negligence.
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StarEmpty StarEmpty StarEmpty StarEmpty Star
Avoid united healthcare sponsored by AARP
Posted by Sjsrss73 on 08/14/2012
I have rheumatoid arthritis - united healthcare is denying coverage, putting constant roadblocks to payments for remicade. Avoid this insurance! I can't wait to change to a Humana plan that will not block payments.

     
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Posted by trmn8r on 2012-08-14:
Remicade is very expensive ($1300-2500 per dose), and insurance coverage can vary greatly depending on where the treatment occurs, what treatment has already been used and other variables, in addition to the insurance company involved. At the cost involved, it makes sense a request for coverage would be carefully examined.

A quick search showed a complaint of non-coverage for Remicade from all the way back in 2004 of a similar nature, company not specified.

Have you discussed this issue with your doctor to see what options you have to either provide whatever UHC may need, or other options?
Posted by Anonymous on 2012-08-14:
I get Remicade infusions and my insurance denied it at first too. My dr had to submit medical records to get it approved. Have your dr submit medical records. I work in health insurance and usually a denial can be overturned with the medical records.
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Insurance Terminated
Posted by NofriendofAX on 12/13/2009
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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Posted by Anonymous on 2009-12-13:
This situation is horrifying. I wish the best for you and I wish I had an answer.


Posted by NofriendofAX on 2009-12-13:
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
Posted by Hugh_Jorgen on 2009-12-13:
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!
Posted by Anonymous on 2009-12-13:
What Hugh said. Good luck.
Posted by Anonymous on 2009-12-13:
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.
Posted by NofriendofAX on 2009-12-13:
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!!!!
Posted by Class Advocate on 2009-12-13:
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.
Posted by Suusan B. on 2009-12-13:
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.
Posted by voiceoff on 2010-01-06:
Congrats on being in remission. The treatments you took were beneficial and needed and they denied them only becuase they were so expensive. It is so wrong to have a person who has faught 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.
Posted by Anonymous on 2010-01-06:
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?
Posted by kristj96 on 2010-07-07:
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 Sucks!!
Posted by PEODDR on 11/11/2008
I am a doctor and have 4 United Healthcare patients. So far in my practice this company has been able to withhold payment from me, send my assigned payments to patients that spent my money when they received my checks, lose claims that have been resubmitted over and over and when I call they act like they do not know where the claims are. They received the claims sent them to their negotiators COALITION AMERICA who try to get me to lower fees which is not legal because that would constitute dual fee schedules. So when I do not answer phone calls or negotiate they began playing games with my money!

I will never accept United Healthcare again and two of my patients are switching to Blue cross and dropping UHC over this. As you know UHC stock has dropped from around 55.00 a share to under 20.00 so they suck! Anyone needing health insurance should avoid this company like the plague because they will not be there for you except every two weeks to take 3-400.00 dollars out of your paycheck. So they want your money but refuse to cover services you pay for. They are the worse insurance company in the world. I believe they are in with BNSF railroad which is not going to use them next year either. Drop your UHC insurance as soon as you can.

If they would drop the negotiators who are trying to save patients money buy charging a fee on claims they negotiate which doesn't make sense they would save the patient money. THEY SUCK stay away from them. Any doctor that works for them SUCKS to.
     
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Posted by Hugh_Jorgen on 2008-11-11:
"I am a doctor and have 4 United healthcare patients."

"Any doctor that works for them SUCKS to."

So can we draw a conclusion from the first and last sentence of this review?

Posted by Anonymous on 2008-11-11:
Yes, Hugh -- we shall.
Posted by Anonymous on 2008-11-11:
You took the words right outta my keys, Hugh.
Posted by Anonymous on 2008-11-11:
LOL Hugh!!

If in fact this OP is a doctor he knows the proper channels to go through to file a legitimate complaint againt United. He can file a complaint if any of his patients are CMS, he can also go to the DOI, DOC, (no pun intended) and so on. My3Cents is a great consumer tool, but if he were a doctor he would know the appropriate channels to go through to file a complaint and expedite payment. Also, if the payment is going to the patient then the doctors staff did not properly submit the claim to United and the staff completed the area of the form that assigned the patient as the party to pay the claim to.
Posted by Principissa on 2008-11-11:
As a doctor, why do you not know the proper channels to go through? I would assume since you are working in healthcare that if the payments are going to the patients, this is not United's issue, this is an issue with your staff not properly filing claims.

By the way, good luck with blue cross, have plenty of prilosec on hand for the ulcers you're going to get dealing with them.
Posted by NeveragainAmazon on 2008-11-11:
All I can say.....Simple....Hm....wonder when the OP's job was terminated with UHC???? Quite funny!!!!!
Posted by Ponie on 2008-11-11:
This doctor expresses him/herself just as some of them write. :) Don't remember ever hearing an 'educated' person using that teenage expression. Except in the case of a baby feeding, but in that case....
Posted by DebtorBasher on 2008-11-11:
When I did medical collections, I was surprised at how many insurance claims I AS A COLLECTOR had to file for people. Was it the Physician, the Patient or the Insurance company's fault..YES, YES and YES...they were equally at fault. I sometimes spent hours filing insurance and BWC forms for the Doctors, patients and Insurance companies so our collection agency can collect the money for the Doctor...
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Poor Excuse For Insurance Co.
Posted by Sahuarita LADY on 06/22/2011
I have had some problem that has left me unable to walk, sit up without support, stand, and only little use of arms and hands, I needed a wheelchair, I had to pay over $1000.00 and when I only get little more than that monthly it is hard.

The company rejected scan of head and DR took it on himself to do this so far we have no diagnosis but if you have this company or thinking of signing with them I would think again as they are not patient oriented.
     
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Posted by Jay on 2011-06-22:
No insurance company is "patient oriented". Without exception they are ALL "profit oriented". Whatever they can do legally to increase their profit is what will take place. If they can legally deny you benefits they will. Sometimes becoming a thorn in their side may help.
Posted by Anonymous on 2011-06-22:
An insurance company can reject a test if they don't find it medically necessary or if you've had too many radiology tests performed recently. They aren't just going to allow these tests for no reason. These are expensive tests and the insurance doesn't want to pay for tests that aren't necessary. Sounds like maybe the ordering dr didn't give enough clinical info for the scan
Posted by Sophia Marie on 2011-06-22:
Of course they are not patient oriented - - they are in business to make a profit. Do you have durable goods coverage that would pay for a wheelchair? If not they they are under no obligation to reimburse you. As far as the scan is concerned, it is your doctor's responsibility to justify the expense and it sounds like he/she didn't do so.
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United Health I don't care Ins.
Posted by Snarklefarce on 09/04/2009
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 deductable 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 thats 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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Posted by Skye on 2009-09-04:
What are you talking about, getting pre-existing meds? Not sure what your complaint is about.
Posted by jktshff1 on 2009-09-04:
The only pre-existing meds I know of are natural ones LOL.
Pre-existing before what?
Posted by DebtorBasher on 2009-09-04:
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.
Posted by andbran on 2009-09-04:
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
Posted by andbran on 2009-09-04:
i meant to say without any hassels
Posted by kristj96 on 2010-07-07:
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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Coordination of Benefits
Posted by JMR in CA on 12/30/2008
SAN DIEGO, CALIFORNIA -- United Healthcare (UHC) is my insurance provider and they are horrible. Luckily I am also covered under my husbands HMO. We mistakenly believed we were both covered by both the HMO and UHC because they issued cards with our names on them. My husband decided to use our UHC benefits for the first time this October 08 for an ankle issue he was having because the HMO couldn't fit him in for several months and he really wanted to have the surgery and recover before our daughter started crawling. I thought, great we can use our UHC benefits even though we will have to pay more out of pocket. To make a long story short we didn't get the proper authorizations beforehand (I am a neophyte when it comes to Health Insurance having been covered as active duty Navy or under an HMO my entire life), and UHC has denied and continues to deny all the claims. The HMO also denies them since it was not done through them. We have sent UHC everything they've asked for and tried to reason with them. I am now looking at a devastating bill that is 3 times what the UHC website estimated for a minor outpatient surgery. If you have a choice in Health Insurance providers do not choose UHC. I sincerely hope that our government will fix this issue once and for all. It is obvious that the regulations in the health care industry protect the insurance companies and not the consumer.

I am lucky to have health care and be healthy but it doesn't seem right that this inefficient system is allowed to continue. Lets take the profit out of health care and focus on covering everyone.
     
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Posted by Anonymous on 2008-12-30:
The way insurance works is that your insurance company would provide your primary coverage, then your husbands would be a secondary payor. Your husbands insurance company would provide his primary coverage, and yours would be his secondary payor. You tried to pull a fast one by using your coverage (UHC) as primary when you should have used his. You also readily admit that you did not get the proper authorizations necessary. How is this UHC's fault? If his primary care physician could not fit him in for several months, you should have called his insurance company to find out what other alternatives were available. Again, the delay caused by his PCP's office is not UHC's fault. If you had followed the proper process, his HMO would have paid the claims (excluding coinsurance payments)and you could have submitted the remainder to UHC, but you didn't and now you are paying the price. If you truly feel you have a valid complaint, contact the California State Insurance Commissioners office and ask them to investigate.
Posted by Starlord on 2008-12-31:
I began with Secure Horizons when it was through Pacificare, and it finally ended up with United. Then they joined forces with AARP. I never had any trouble with them in Arizona, but since we moved to Washington in August, I have had nothing but trouble. They have sent me four (4) ID cards, each with a different doctor's name on it. If you see any other doctor, they refuse to pay the bill without a big fight. I saw my doctor yesterday (you CAN find a doctor who takes new patients in Washington, but it ain't easy)but my card still had one of his partner's names on it. I was told on the phone three weeks ago I would have my new card in 7-10 days. It is now 21 days. I checked out Puget Sound Health Partners, and lo and behold, it is Secure Horizons, too, which means United Health Care. They may be United, but they don't know from beans about health care.
Posted by jenjenn on 2008-12-31:
When it comes to insurance, you cannot choose which plan you want to be primary.
Posted by Anonymous on 2009-01-04:
jenjenn you are absolutely right. Each employees insurance through their employer is their primary coverage. Their spouses coverage would be secondary. We cannot flip flop.
Posted by JMR in CA on 2009-01-06:
You are all technically correct but I think the whole system is wasteful and in need of serious reform. I will be dropping UHC ASAP since I've recieved better care and customer service from Kaiser as my secondary insurer.
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United Healthcare Problems
Posted by Lynie on 06/05/2008
CALIFORNIA -- I have had United Healthcare as my insurance provider for the past year. I have never had so many problems with a health insurance company before. Here are the issues that I have had with them;

1) They told my chiropractic office twice that I don't have chiropractic coverage. When I called they confirmed that I did have chiropractic coverage.

2) I have filed claims that have been unpaid.

3) They dropped me from the insurance plan and claimed that it was a computer error. It took 3 months to get another card with my name on it.

4) I had surgery. Normally, insurance plans cover extra physical therapy with surgery. They did not. I've been stuck paying for many therapy session and it is not considered "out of pocket".

These are just the problems that I remember off hand. I recommend against having United Healthcare as a provider.

If anyone knows of some kind of action that I can take please let me know.

     
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Posted by dan gordon on 2008-06-05:
I'm sorry that you didn't clarrify what YOUR policy covered before you went to the doctor. Blamining the carrier for your issues really isn't fair. They offer many different policies that cover different things. Its up to you to find out what the coverage is. Its even on the home page for you to check out your doctor. I went to the hospital today and had I used the drs office I would have been stuck with a $1500 bill but when I called United they suggested a close by hospital where things were covered 100% Sorry for your problem, but you would have that problem with ANY policy
Posted by Anonymous on 2008-06-05:
I agree with Dan. If you pay for your own policy, you should up the coverage. If you get your insurance through your employer, tell them the coverage that they are offering to their employees is inadequate and that you would like them to reconsider offering a higher coverage policy with United.
Posted by jenjenn on 2008-06-06:
When your coverage begins, you are given a summary plan description that tells you what is covered. It is up to you to know if you have coverage for a certain procedure, such as PT.
Posted by Anonymous on 2008-06-06:
The benefits page of the policy lists what types of service are covered. Never rely on what a provider's office tells you and never rely on what the insurer tells you on the telephone. If it is not on paper, you don't have the coverage. Why have the claims you filed been unpaid. I'm not sure why, today, someone would be filing their own claims. The provider typically files. If not, there are services available to assist you. "Computer errors" are reliable only when a business cites them. If a consumer misses a payment or other obligation d/t a 'computer problem, 'tough cookies'. If you think United is improperly denying or delaying payment of legitimate charges, contact your state's insurance commission. Cheers!
Posted by JMR in CA on 2008-12-30:
This health insurance jumping through hoops is insane. Why are we as consumers/voters allowing it to continue. Based on everything I've read about UHC it seems like they are not being honest. It shouldn't be this hard.
Posted by Nothappy333 on 2009-07-14:
You're not the only one that has had problems with the chiropractor. I am covered by our UHC but every time I go I have to fill out a paper that takes time, and so does my chiropractor. It got to be such a hassle and I had to pay 20.00 co-payment, that I just decided to pay the 27.00 for the whole thing and save on the paper work. This UHC is a rip off!
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