United HealthCare Services review: Dental department

Case no. 1: I subscribed to UHC Insurance for a few years. UHC offered dental benefits of ($1000.00)/year. I also had Delta Dental insurance. I informed my dentist then of both insurance policies. In Feb 2023, UHC sent me an explanation of benefits (EOB) regarding my dental work in October of 2022. I called Delta Dental, and they told me that they paid him only for his material cost, not labor, as it was repeat work for the third time. The rule was that he is not to charge for it. A crown is to last at least 7 years to be considered a new job. And he had charged me every time he worked on the same tooth (the 3rd time he had charge me $185+ payment for Delta Dental). Therefore, the claim submitted to UHC which drained my benefits, was unjustified. After several e-mail messages, agreed to refund my ‘out of pocket’ amount, and eventually he agreed to return UHC money ($668) to them. The claim was presented and paid in Feb 2023, and I requested the refund in the same month on the ground that it was my benefits and the dentist’s claim was unfair because it was repeat work. I spoke to UHC several times, but they denied to refund me the money because the account from the previous year was closed. The account was open for the dentist but not for me (UHC policy holder.) To my knowledge, he never returned the money, as UHC refused to confirm or deny it. (I have all the documentation)

Case no. 2: Moving to a new dentist, and learning from the experience, I asked UHC if they would refund me, if I pay out of pocket first. The response was ‘absolutely’ as it is my benefits and I am entitled to use it the way I wanted for my dental needs. I worked with Dr. K. At one point they asked me about my insurance and I told them about UHC as my health insurance carrier with limited dental benefit. I never authorized them to bill my insurance. After doing a crown which I paid for in full as agreed, he presented a claim for ($875) while UHC-Dental was processing my refund. UHC diverted my refund and paid the dentist. When I talked to Dr. K., he agreed to refund UHC. To my understanding, he returned the money to UHC. About a month ago, I called UHC and they went through investigating again and calling the dentist’s office etc. and I was told that it will take 90 days. This is the third attempt. I think when the time comes, they will start all over again, because on my second attempt, I was even given a reference number as the case had reached sending me a check, but it never came and that is why I called for the third round. Until now they have refused to give a reason for not issuing the refund.

It seems that there is an unspoken alliance between the insurance companies and the providers on the account of the patient. I wonder if medical schools teach law and ethics in conducting business transactions! I have no recourse. Can you help? Thank you.

Sincerely,

Nemat Sharif