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UHC Health Insurance Informative - It's A Combination Of Everything!!!

Review by timbucktwo on 2009-12-08
I see all these complaints, which are valid complaints. I agree with some of them. What most people don't understand is that the EMPLOYER makes the policy-not UHC. The EMPLOYER says what percentage is covered or not covered or if you have a 3000 Deductible or what co-pay you would be paying for a specialist or regular physician. The prescription drugs that are covered or not covered are defined in Tiers. Their are general off brands of certain drugs which fall under tier one two or three. The EMPLOYER defines how a certain tier would be covered or not covered. UHC only administers the benefits and processes the claims. They do have a messed up system and bad communication between departments on appeals, pre-Determinations, and notifications/authorizations, but you have to understand that the POLICY BENEFITS were chosen by the EMPLOYER!!! As for communication between the Dr's and Insurance, thats where it gets tricky. Billing departments have issues and bill claims incorrectly all the time. Their are standard practices in billing the correct codes (hcpc, cpt, icd-9 codes), billing departments mess up claims all the time! Most of the time a claim is denied from the insurance because the way a provider billed and submitted a claim. I am rambling now...

Bottom line is.. its not just the insurance. You need to educate yourself to know what the situation is before you call into your insurance company and yell at the guy on the phone-who is trying to explain to you the situation at hand. Don't be one of those guys calling in yelling at ME please! EDUCATE YOURSELF!!
Comments:2 Replies - Latest reply on 2010-01-12
Posted by Starlord on 2009-12-08:
Hey! I don't have an employer, and UHC backed the insurance company I just told to take a hike. I hate to rain on your parade, but UHC makes all those decisions, as does Blue Cross/Blue Shield, as does Medicare. If left to the employers, you would pay 100% of your medical bills. Who were your instructors on this theory of yours; Larry, Moe and Curly?
Posted by NurseJennie on 2010-01-12:
Just to clarify. UHC presents a variety of plans, which has pre-determined coverage attached. It's up to the employer to pick a plan, based on what they can afford and the coverage they want for their employees.
As far as I am concerned, Whole foods has the best idea.

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