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How does United Health Care CEO make $46 million (rant)

simbasimba Posts: 6,092Registered User Senior Member
edited May 2012 in Parent Cafe
By denying claims.

I have been struggling with United Health Care for the past SIX months for paying the lab tests as a result of an annual physical at a laboratory that is in-network.

My son went to the doctor for his annual physical, the doctor ordered a blood test. United claims that the claims submitted by the lab consisted of 1. Blood draw, 2. Metabolic Panel, 3. Hepatic Panel, 4. Lipid Panel, 5. Thyroid and 6. WBC blood count.

(Note that the lab results for Metabolic Panel and hepatic panel equals the results for Comprehensive Metabolic Panel. (2+3 = Comprehensive panel)).

They did pay for the doctor visit 100% as it was for a preventive care (my policy covers lab work also 100% as part of the physical. Wife unit and I had exactly same tests done as part of physical, and we did not have to pay).

Initially, they refused to pay for any blood work saying that those tests were not for preventive care they were diagnostic (if classified as diagnostic the claim is subjected to deductible and 20% co-pay).

Then they agreed to pay only for Lipid Panel (even refused to pay for blood draw). Then after a fight agreed to pay for WBC blood count, then Thyroid, and then finally blood draw (I had to argue that how can they do all those covered tests without drawing blood).

They claim that because of Obama Health Care reforms Metabolic and hepatic panels are diagnostic, but comprehensive metabolic panel is preventive (I have heard about Obama health care reforms six different times).

Imagine going to MCD with a free coupon for a happy meal, but the cashier decides to break down the chicken, fries, drink, and the toy and then saying that the happy meal coupon is not valid.

I just do not know how to proceed with them. Every call is handled by a different idiot. That idiot just wants to pass the buck, and it is in their advantage to keep on wasting time – they must be charging my employer for the time spent on me.

Sorry for the rant, but any suggestion would be welcome.
Post edited by simba on
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Replies to: How does United Health Care CEO make $46 million (rant)

  • dstarkdstark Posts: 28,083Registered User Senior Member
    Lol.......

    You have the system you want....
  • jordansmomjordansmom Posts: 122Registered User Junior Member
    My suggestion is that you document everything and write a letter to United Healthcare (key is written documentation) and copy it to your state insurance commissioner. That should get their attention.
  • romanigypsyeyesromanigypsyeyes Posts: 22,717Registered User Senior Member
    By denying 21 year olds treatment because they're "out of network" at school.

    Oh wait, that's my insurance.

    Carry on.

    I don't know the solution. I've done more fighting with insurance companies than I've ever done battling any illness. I know what you're going through and I have no advice, just compassion and shared frustration and anger.
  • suzy100suzy100 Posts: 1,842Registered User Senior Member
    Do these things:

    1. Tell them that whomever wrote their script about the Patient Protection and Affordable Care Act ("Obamacare") does not have the authority to deny this claim; and

    2. Get a manager, get their name, number and email address. Get one such manager assigned to your claim - insist on in - and;

    3. Copy the Department of Insurance on all correspondence. This will depend on whatever state you are in. I can tell you that correspondence to the state DOI will get attention; and

    4. Be relentless.

    5. Be relentless.
  • hops_scouthops_scout Posts: 3,898Registered User Senior Member
    How do people even begin to think that ObamaCare is going to fix this problem? News Flash: It won't!
    My son went to the doctor for his annual physical, the doctor ordered a blood test. United claims that the claims submitted by the lab consisted of 1. Blood draw, 2. Metabolic Panel, 3. Hepatic Panel, 4. Lipid Panel, 5. Thyroid and 6. WBC blood count.

    (Note that the lab results for Metabolic Panel and hepatic panel equals the results for Comprehensive Metabolic Panel. (2+3 = Comprehensive panel)).

    It may be a matter of the lab re-submitting the claim. They may be the reason that it is getting denied. Dumb? Yes, but something to check..
  • HuntHunt Posts: 22,246Registered User Senior Member
    I just have to note, at the risk of being political, that if Obamacare hadn't passed, your insurance company would be telling you that they would have covered these tests if the law had passed. I agree with the advice to copy the insurance commission.
  • minimini Posts: 26,431Registered User Senior Member
    Move to British Columbia, and you'll be just fine.
  • NJresNJres Posts: 5,261Registered User Senior Member
    How much money are we talking about here? I am sure what you are going through is very aggravating but I think there are bigger fish to fry. The Charlotte Observer kicked off a 5 part series today on the huge profits made by our non-profit hospitals. Lots in there to make your blood boil.

    Prognosis: Profit | CharlotteObserver.com

    There are already 10 stories linked on that page. I am having a hard time understanding how a veteran ends up responsible for $hundreds of thousands in medical bills.

    http://www.charlotteobserver.com/2012/04/21/3189787/hospital-sues-veteran-for-almost.html
  • dstarkdstark Posts: 28,083Registered User Senior Member
    Nice links, NJres...
  • kelsmomkelsmom Posts: 12,512Super Moderator Senior Member
    Dang, I just lost my long post. UHC posts its preventive care coverage info: https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesHtml/ReimbursementPolicies/PMED_Prev%20Med_2012B.htm#PMCodes. Coverage of tests varies by age. It also seems to vary by personal and family history: https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Preventive_Care_Services_CD.pdf. The physician should be aware of all this if he is in-network (a good electronic records management system makes this possible).

    My D has to pay for a thyroid screen during her preventive care exam, as it is not a preventive test. It's confusing, because a normal person doesn't know what should & should not be covered ... and it changes as the standards for preventive care change. There has to be a better way to do this.
  • NewHope33NewHope33 Posts: 6,208Registered User Senior Member
    "It may be a matter of the lab re-submitting the claim."

    This reminds me of a funny story ... or not-so-funny, depending on your view point. We had one of these "can't figure out why this claim hasn't been paid" scenarios. Not United, but another big health insurer. We thought we could resolve the problem by re-submitting the claim. The second one came back "Denied - Duplicate Claim." Hey, no problem right? At least we know they got the original claim. Three days later the original came back "Denied - Duplicate Claim." The second was duplicate to the first ... and the first was duplicate to the second.
  • jym626jym626 Posts: 35,954Registered User Senior Member
    UHC is awful to deal with.
  • SkyhookSkyhook Posts: 1,095Registered User Member
    My insurance used to be fairly simple to understand (pay the co-pay and get the service), but now there is a deductible and all kinds of paperwork is mailed to my home. I'm told I should check this paperwork to make sure it is accurate.

    I'm starting to think I need to hire an accountant to keep up with my health care finances.
  • SkyhookSkyhook Posts: 1,095Registered User Member
    I really think we need to go to a system where costs are posted in advance. Health care needs to be like any other product or service we decide to buy.

    Example:
    I injured my foot. It was healing ok, but I was a little worried about infection. So, I went to a wound specialist at the nearby teaching hospital. They put a great dressing on it, gave me great advice, etc. Told me to come back for follow-up, which I did, two more times.

    I have NO idea how much this is gonna cost me, or my insurance. But if I knew, I might have decided to let it heal on its own.
  • hops_scouthops_scout Posts: 3,898Registered User Senior Member
    I really think we need to go to a system where costs are posted in advance. Health care needs to be like any other product or service we decide to buy.

    The trouble with that is it's difficult to know what exactly is going to be done.

    For example: With surgeries, the surgeons don't always know what they're going to fix. They go in to repair a hip labrum tear and find out they need to shave some bone off as well. Do you want them to fix the labrum and leave the bone since they only quoted you the price of fixing the labrum?
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