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My health plan with United HealthCare states that it will pay 80% of "eligible" expenses after $400 deductible. I have weekly outpatient therapy sessions, and my doctor is an out-of-network provider. My plan states it will pay for out of network or in network once I have met the deductible of $400. I have met the deductible, but they continue to deny my benefits and reimbursements. I've called, the representative said they (United persons) were putting in my "old" United account number that I had with a previous employer. She said she corrected it, but recent claims show again I have been denied. I'd like to know if I can take any further action with this - this is my plan through my employer.
Thank you for your consideration
My Plan states:
80% of eligible expenses after satisfying $400 deductible.
Any combination of Network and Non-Network Benefits for Mental Health Services is limited to 52 days per calendar year.
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United Health Care (UHC) is a very corrupt company. They act as though they don't know how to process claims, communicate with each other & plain just act like they don't know what is going on at all times when it comes to taking care of the patient or the provider. When they do claim they do know what you are talking about & you call back, it "must have got lost in the system". There are laws to protect you. Call your states department of insurance commissioner & you will also see the lawsuits UHC has had to pay for these same practices. Good luck with a very fraudulent company & take action, your voice is statistically worth 100!
United Health Care sucks ###. I am going to sue the hell out of them.
I had problems with United Healthcare as well. My company sold off a business unit and I was switched to another business unit rather than go with the sale of the company. As a result of this partial sale, my united healthcare number was changed to a new ID number but I was still with the same company. United Healthcare never informed me or my company of the new id number and I continued to file for several months under the old united healthcare number. Then out of the blue I start getting calls from my doctors saying I am uninsured and that United is refusing to pay. After many calls, united admited they had changed my ID number and it should be easy and quick to resolve the issues... but this was not the case ... When I found out the error I resubmitted all my claims immediately with the new number as they instructed me to do. For almost four years I continued to have these claims denied. Every time I would call they had lost my records or the person I last spoke to was no longer with the company. I finally gave up going through the normal channels after several dozen calls and many unfulfilled promises from the staff. I began calling United Healthcare corporate and was persistent to speak with a manager at corporate. Finally I was able to find some who helped but it took a lot of time and multiple calls even with the corporate help finally agreeing to pay my claims. Almost 4 years of going round and round and these weren't even big claims.
i also have problem with United health care . they denied the claim . and the hospital ; s bills was sent to collectin agency, i was paying 200 dollars a month for 2 years till i found out a peice that i was covered, i called them and they said the claim was rejected incorrectly, they had to send the check to the hospital and the hospital deducted what i owed them and they send me the rest of the money . the thing i paid the other providres alomost 16 hundreds dollars . i called them they said they dont have a record of the claim . i called the doctor office they said they submitted the claim was denied by the united health care insurance . till now i dont know what rto do with them they made my credit bad and i went through alot .
united health care made mer suffer for two years paying the hospital bill . and i was covered and they denied it . even they paid the hosptal after 2 years of strougl on my side . they still sdont want to pay the providers. andwhat should i do to make them pay ?
There should be no problem paying the provider if they agreed to pay the hospital. I would make sure that they understand that you suffered as a result of their negligence. Call the consumer affairs department and request that they reprocess the claims (all of them). Demand that they also pay the penalties and interest that are due as a result of their negligence. If they still wont cooperate then call the department of insurance and file a complaint. Moving forward always document the time, date and person you spoke with when you called. Ask them to provide you with a reference number to validate the conversation.
UHC is ridiculous. Does not stand for United HealthCare... more likely Unbelievable Hypocritical CRAP!
I am a Breast Cancer survivor and had one type of reconstruction that did not work because of 3rd degree burns from radiation. I am in constant pain, for multiple reasons and there is easily discernible visual deformity... I contacted UHC to locate a DIEP surgeon (this is the only real option if basic expander to implant surgery doesn't work) - someone from their nurse line called me back saying they did not have a specialist after they contacted 15 in-network providers.
Then they told me to file for a Gap Exception for consult - which I did. I located Dr's who do this procedure and gave them all the information as I was instructed to do. They denied the exception for different reasons (let's revisit - same procedure - same need - just different doctors) 1 was denied because they tried to call me 3 times in one day and I did not get back to them that day... (BTW I had told them I would be out of town - and they advised me to call and check the status in 4-5 days) and then one was declined because they said they have in network Dr.'s.. The first name they tried to give me was the doctor that did my original FAILED surgery - so I quickly explained they were wrong he did not do the necessary procedure.. they then sent me a letter with 3 names so I contacted the Dr's they gave me and the staff at each office stated they do not do that type of surgery.
So I sent a letter detailing this to UHC and expressing my concern that whoever is making the decision does not understand the procedure and that not all breast reconstruction after cancer is successful especially when there is damage from radiation. I also sent along a Clinical Gap Exception request (which one of their reps told me is what I needed to do) from my Primary Care Physician.
Still they are ignoring me. I do not understand. I have done everything you have asked. Believe the [censor] out of me - I would just have assumed not GETTING Stage 3 Breast Cancer at 43 years of age and needing 2 rounds of Chemotherapy - a double mastectomy - 2 additional surgeries and then daily radiation that caused 3rd degree burns... But it happened. Now it is time for UHC to do what they are supposed to do - provide care.
1) They gave me three supposed in network providers for my child's therapy. None of them were the right specialty. Then they told me there was another one that would have been a one plus hour drive each way in traffic for weekly therapy. I told them that the provider was not within 30 mile radius as evidenced by google maps, which showed a distance of 25 miles. They told me in their system it was within 30 miles since they do it by zip codes, whatever that means. For that reason, they denied my network gap exception and I have to pay out of network copays.
2) For about 30% of claims I submit, they falsely deny them. Today I got one back with a cryptic message saying I should submit information about the claim, even though that information they asked for was already submitted and in the same explanation of benefits where they said the information was missing. When I called them, they said it should not have been denied and they have systems issues preventing them from resolving claims properly.
My job switched to United August 1st and I have spent countless hours on the phone with them since then. One, I am seeing a Certified Nurse Midwife for my pregnancy and there are NO CNM's in-network. They said I should submit a gap exception request so I got my GP to try to send one in, only for her to be transferred so many times and put on hold for so long she finally called me and said, I don't have time for this - I have patients! I called to try to get the info and was transferred over and over again between different departments and several times back to general "member services" before I found someone who could give me a fax number. I'm assuming at this point the request will be denied. Additionally, I have asthma - and when I went to pick up my 2x/day asthma prescription on monday (that my asthma specialist prescribed!) I was told united will only cover it once a day, and I have to appeal that decision in writing and have my doctor send a statement of medical necessity. I thought that's what a prescription was?! And how does an insurance company get to decide what's an appropriate dosage for me, over the advice of a pulmonary specialist?! Their advice to me until the appeal is resolved is to just pay out of pocket, and this med is $80 for a 15 day supply for me. I can't afford that. I tried to call and ask if there was any kind of emergency interim exemption I could get until the appeal is done (which I am guessing will take forever, based on my other experiences with them) so I can continue to take my medicine as prescribed, seeing as how I am pregnant and an asthma attack right now could severely impact both me and the baby, and I was told that I do have emergency coverage under my plan so if that happens I should just go to the ER. Isn't it nice to know I have emergency coverage if I have an asthma attack and my baby dies, I can just go to the ER! Such a great company. I can't believe they are willing to accept the liability that comes along with telling customers things like that, or that they are willing to put a mother's/baby's life at risk over paying for a drug once a day instead of twice. NO ONE that I talked to had a phone number for the appeals department either, only a mailing address. Convenient.
The only complaint I have with United Health Care is their method of dealing with out of plan doctors. Our Doctor’s office called into United Health Care to get the authorization to do surgery on my wife. They were given the ok and the amount we would be responsible for. When the bills were submitted by the doctor’s office they were paid at the normal and customary rates for out of plan. They knew that the doctor was out of plan and neglected to tell him about the out of plan service called “Gap Exception” which would have covered most of the bill except for the $30 office visit. So we are told that the total amount we owe is over $2, 500. Sounds like Kaiser who in the past stuck me for $6000 +. I plan to file a complaint with the State Insurance Commission and with AT&T who my retirement plan is through.
I got a call today from the EMS service that responded to a 911 call on Oct 7 2011. The night my husband went into cardiac arrest and subsequently died. They originally sent me the entire bill and I informed them that we had perfectly good coverage and to send the bill to United health care. That was in Nov 2011. Today was 6 months later and I got a call asking me to pay a remaining balance of $1700. They couldn't tell me the reason that United had denied the rest of the claim, so I called United and told them it was a 911 call that evening. They told me that the EMS responder was an out of network one. I'm sorry..but in an emergency situation, I wouldn't think to ask the 911 operator if they are an in network ambulance! Who ever heard of such a thing! I don't know who they are going to send out..how can I possibly know? I'm giving my husband CPR and trying to keep him alive..but I'm supposed to find out if they are in network? I've never heard of anything more ridiculous and insensitive in my life. I will be filing an appeal with United.
Denied inpatient physical therapy after a crippling stroke, that was supposedly "mild" but severely incapacitating. A 95% recovery was expected, but immediate inpatient PT was strongly recommended. . A week after my discharge, they sent me a letter saying that was an erroneous decision - they should have honored it. But once discharged, the hospital said I was ineligible for the inpatient PT program. PT was delayed and as a result 18 months later I still have very significant physical disabilities that would have been much reduced had timely PT been instituted. I'm looking for a lawyer. This is an eff-up that likely significantly delayed and possibly permanently limited my recovery from the stroke.
The same thing is happening to my husband currently. Did you find a lawyer to assist you? UHC sent me 3 denial letters last week for a CT scan (stroke 12/21) ordered by his Neurologist. They denied a custom wheelchair which he desperately needs. They discharged him from inpatient rehab after 2 months of appeals to get him there. It has been an absolutely awful experience dealing with UHC and they have neglected my husband by delaying treatment after his stroke when timing was of the essence.
As a retired Navy with Tricare (administered through United Healthcare) I also have insurance through ALLSAVERS (Another United Healthcare administered policy) Below is a statement which I sent to The office of Senator John McCain of Arizona United Healthcare sent me and the senator a response which they state justifies their reasoning for refusing payment. It seems to me that they should be finding ways to address their members health rather than putting so much energy into finding ways to deny claims. UHC is starting to make the VA look good.
Before reading this letter and deciding I am just bucking the system, Be advised that I have followed the directions provided to me, and have made many, many inquiries for directions with little to no success. With this in mind please continue to read.
I am Looking to anyone who can provide me direction and relief with the issues I have experienced getting my family and myself consistent and adequate health care coverage through Tricare since United healthcare assumed the administration of military healthcare benefits.
There has been much attention given to the gaps in treatment for Veterans through the VA. The administration of Tricare health coverage has become a nightmare in comparison. Tricare Providers are dropping out due to extreme billing issues; it takes months to get appointments for Specialty Care for myself as well as my family. When we do get appointments, on almost every occasion I have had to make multiple calls to get billing issues corrected.
Let me provide you some details on the issues I have had.
1. In Late November of 2014 I sought inpatient treatment for PTSD/Depression which was the result of the loss of my entire family (father, older brother, younger brother and mother) all to separate accidents while I was deployed. In setting this up I went to Luke Air Force Base and consulted with referral services. I was told that the service was covered and tricare would follow the rules of the Primary insurance. Based on that I scheduled myself to be checked in on January 3rd. After my treatment I filed a claim with UHC.mil otherwise referred to as Tricare. My Claim was rejected 4 times for additional information which I provided each time. The claim for $4000 was ultimately denied because the provider had opted out as a Tricare provider on January 1st due to problems getting paid through Tricare. This Opt Out occurred 3 day prior to my admission however had not been updated due to the holiday. I was being denied reimbursement over a 3 day difference filed several appeals with no results.
Tricare has closed all of its local offices to the end that there is no ability to find face to face assistance with issues. Each time you make a call you connect to a different agent who only knows what they can see on their screen.
After almost 18 months of resubmissions and appeals I made several visits (3) to Luke Air Force Base and spoke with the Patient advocate. I was excited on my first visit that I might finally make some progress. Unfortunately I never received the follow up calls or emails I was promised. This was true for each of my subsequent calls.
Do you get the feeling nobody cares? that is how my family and I feel.
2. January 28th 2016 I was laid off and thus lost my primary insurance. This only lasted 4 months, however UHC.Mil immediately reverted my families Primary Care Physician to Luke Air Force Base. They never notified us or our primary care doctors. This resulted in all of my family’s specialty care appointments to be cancelled. Tricare insisted that we had to get new referrals however they still neglected to notify us of our PCM Change. This resulted in continued rejection for care. 4 months later when I Found out they transferred our PCMs to 56th Medical Group at Luke AFB I informed Tricare that we had already been granted waivers to seek PCMs outside to the 56th Medical group due to their inability to provide consistent care. Here is an important key. When UHC took over Tricare from Triwest, the transfer no records of historical information. They made us go through the whole process over again.
Just as an example my wife and I suffer from sleep apnea, and to get our masks and tubes replenished they required us to get a referral from our PCM to a Pulmonologist for him to refer us to a sleep study, although we have used CPAPs for 10 years. It took us from November 2015 until October of 2016 to get this process resolved.
I have been anti depressants for several years for what they refer to as PTSD related depression. I have had to change physiatrist 3 times as they decided to drop tricare because of difficulties in dealing with UHC.MIL.
3. Just this morning my 22 year old daughter who remains a full time college student was turned away from her Dental Appointment. I was informed that although I had updated DEERs as required, DEERs neglected to update Delta Dental.
I have made 3 trips to LUKE AFB to seek guidance from the 56th Medical Group Patient Advocate and did not receive one follow up email or phone call as promised.
A recent UHC.MIL news letter said it is the patient’s responsibility to confirm the provider is still an authorized provider the day of the appointment. That means that an appointment which it took me 2-3 months to get could be cancelled because they have chosen not to tolerate UHCs handling of tricare.
I hope than you can appreciate that each time I have to file another appeal, make a phone call, and make a trip to the doctor’s office to be turned away it is time off of work, missed school and repeated delays in getting care.
As a Proud 21 year Veteran of The finest Navy in the World I expect nothing less than what was granted me when I transitioned to the Fleet Reserve. However what I have found is rules changing without notice and a determined reluctance for Tricare to assist me in correcting any of the past issues and rejected payments of the last 2 years. This is all while UNITED Healthcare reported it highest profits in years.
Whether in the VA system or a Veteran with Tricare we all deserve to get the care that those who served as well as their families were promised, and our government is paying for.
UHC has denied a legitimate claim for my stepmother, who was prescribed an oxygen generator for her COPD and cancer. The machine was purchased in February 2020 and been fighting for reimbursement since. My stepmother passed away in January 2021, and my 85 year old father and I have been fighting for almost 2 years - each time getting a runaround, more demands, "lost" claims, and each time they promise to pay within 30 days (of course they do not). I have filed a claim with California Insurance Commissioner today on behalf of my father - one should not be toyed with for 2 years in hopes my father will give up on a $4,000 + claim! Shame on you, UHC!
United Health Care denied my medical claim for a walker because they said I have another insurance, "Delta Dental". I said why on earth did you summit a medical device to a dental insurance company after my hip surgery. Now on the line with a person that I can't understand and there are no managers or supervisors to talk to. Going on one hour now. Wish we could bill them for our time.