My husband retired a few years ago and since then he is on Medicare and United Health Care for supplemental insurance. I only have UHC since I’m under 65. We’ve had terrible service from them but can’t really change because it’s provided through my husband’s company although we pay the premiums. Although I am going to look into getting our own. It can’t possibly be as bad as this.
For the last few years, we’ve had to pay for our prescriptions out of pocket and them submit them to UHC to get reimbursed. I do this every two months. I can’t do it more often because UHC messes it up so badly every time and I’m hoping to avoid over lapping.
I submite them by mail and also fax them. I put them in the same envelope because in the past they have claimed that they get one of ours but not the other. So now when they make that claim I know they are lying.
The excuses I have received in the past for not processing them have included:
Not legible (Yes they are)
Received one but not the other (sent in same envelope, and faxed together)
Incorrectly processed
Met Lifetime max (not true)
Paid the pharmacy instead of us.
Need an EOB from Medicare (for only one of the claims in 2014 but not all? And for only part of the claims in the same period?)
Not yet processed. That was today. I mailed and faxed on January 3. Today is the 20th.
I don’t know what else to do. I give detailed notes on who I have spoken to and what they say. Dozens of different people that I have spoken to cannot help. They promise to call back and never have. Just for the September and October claims I have spoken to eleven different representatives. I spend hours on the phone with them for every claim. Today is January 20 and I have yet to receive a check for the outstanding claims that were originally submitted on November 3, 2014.
UHC has suggested a file a grievance with them but I can’t see how that will help.
File the grievance. Then think what government agencies you can complain to. State AGs office? Easy to make a complaint in most states. Does your state oversee health insurance? Insurance commissioner. Is there a way to pull a federal bureau in? Do it. I have had insurance issues as well over the years and state regulatory bodies have been a big help. The insurance commission has been a good source of advice, even on health insurance, even in the old days. The AGs office is more of a stick approach. Might shake up a sloppy company to get a call from the consumer affairs division.
Then the internet. Is there a Facebook site you can complain on? I must be turning into an old crank, but I have had some luck with public shaming when I have had issues with some entities (not insurance companies).
Does the UHC insurance come through your or H’s company? If so, is it large enough that there’s someone at the company, such as an ombudsman who can step in on your behalf? UHC has to be working with someone at the company whenever their renewal comes up, so there must be someone somewhere who knows who to call at UHC.
We went through this a year or so ago and finally had to involve someone in HR where H works. That person made some phone calls to UHC and pretty soon after that, things started getting straightened out. And we had the name of someone up the authority chain to call if things got messed up again.
In the future, if this happens to us again, that HR person is who we would go to, but much sooner than the last tie.
I’ve called HR and all they say is that they are aware of problems. And even when they finally pay a claim, the next time there are just as many, if not more, problems. We submit he claims every two months and it usually takes about six weeks to get them paid. This time it’s been ten weeks already. They keep coming up with new excuses.
I’ve also been in contact with a lawyer for UHC because at one point, the hospital sued me for non payment due to the fact that UHC refused to pay the claims so we added UHC to the court case. It took over two years to finally get them to pay.
My daughter had a UHC policy in college and we had similar problems. Same story: every runaround and lie in the book. Big one for me was that they lied about procedure codes - said that something wasn’t covered because the procedure code was for X , which wasn’t covered --when in fact the code was for service Y – which was --and of course it took me 2 minutes to look the code up online. (I was dealing with it because my daughter was studying abroad at the time bills came through and the claims need to be processed). This was all for a pre-authorized service as well.
I finally had to get the college involved - the person at the college health care services who is responsible for coordinating insurance benefits. That fixed it, and the college went with a different company the following year.
If your husband is retired I’m thinking you should be eligible for insurance through an exchange – it may be “through” the employer, but it’s not your employer and the employer isn’t subsidizing the premium, so I think you would qualify. Open enrollment ends on February 15 – why don’t you check your health care market place and see what else is available?
Does the policy allow for pharmacy mail order? I agree Lizardly, file the grievance, contact your State’s Attorney General. About 6 years ago, my mother had UHC as her supplemental provider through her former employer. I had the same problems as you described. Somehow, I found that the call center, (I think it was somewhere in Georgia), was easier to deal with than when speaking with the NY call center. When I told the representative this, she gave me another number to call, and from then on I reached the call center in the South and problems while still occured where resolved and dealt with quickly.
We have had Anthem, Aetna, Cigna, Health Net, and United Health Care in this family. UHC was far and away the worst. I would never contract with them unless absolutely the only choice available.
File a complaint with your state insurance commissioner. Keep it short, with details in numbered points. We had a problem with UHC, I filed with our state, and within a week I had a call from the executive office special resolution team from someone with the knowledge and authority and willingness to fix the problem.
@calmom : Thanks. I’ll look into the exchange. Last time I looked into this though, the first question was: are you on Medicare and if you are, then you’re not eligible. Does the exchange sell supplemental insurance? I might just go to Blue Cross directly. I really can’t stand UHC any more. Even if I have to pay a little extra. Guess it depends on how much extra though.
That’s what I thought. Thanks. If we don’t qualify for subsidies, can I just call Blue Cross and find out how much for supplemental for him and regular for me? So we can just purchase it together?
Of course --but be aware that for you, the off-exchange open enrollment period is the same as on-exchange – you need to make a change for 2015 by Feb 15th at the latest. Also, I don’t know anything about how supplemental medicare insurance is packaged or sold, so I don’t know whether you could purchase a policy from Blue Cross “together” or would have to opt for two different policies.
An insurance plan is only as good as what your company has purchased. United healthcare has very specific billing rules and many different plans. They usually manage large companies plans under different umbrellas - and how they operate is different than how most insurances work. Blue cross has different plans and you pick which plan - by deductible, benefits, prescription, etc.
Regardless of which employer contracts with UHC and what benefits they have purchased, and whether or not the company is self insured or not, I agree, UHC is by FAR the WORST insurance company currently out there. Cigna is a close second. But UHC is horrible. Could go on for pages about the garbage they pull. Its not the employer, its not the benefits or packages/services an employer buys or contracts with with UHC, its UHC. They suck. Plain and simple. Agree-- file a complaint with the insurance commissioner and go to your HR Dept if there is one (dont bother with your benefits dept.- they wont care). The only time we havent had a major problem with UHC is the AARP medicare supplemental policy. UHC has been fined in the past for egregious practices. Google Ingenix and read up on that dishonest side business, which they ultimately closed and reopened under a new name. I dont know how those people sleep at night.
It has nothing to do with what our plan SAYS it covers. It has to do with how UHC actually handles the claims. It takes them months to reimburse us for submitted claims. They make up excuses why it wasn’t handled correctly. They tell us they didn’t receive a submission for me after they have paid my husbands even though it was mailed in the same envelope. This last time they only paid part of the claim because they said the parts they didn’t pay were illegible even though they were on the same page as the ones they did pay. It took almost four years to pay some claims and that only happened when my lawyer suggested I allow the hospital to sue us so we could force UHC into the suit and they would have to defend it in court. They eventually paid.
I spend hours and hours on this. My husband had suggested we just pay the hospital to avoid this but I figured it would only encourage UHC not to settle claims if they figured we would just pay.
I run the office for my son’s company. The insurance agent we use gave us health insurance quotes from UHC and BCBS and even though BCBS came in slightly higher, we went with them. I hope never to have to deal with UHC again. I just wish there were somebody at UHC that would listen to this and do something about it. I’m also an accountant and tell all our clients to avoid UHC if at all possible.
UHC gets away with it because people don’t push it enough with them. They are horrible and inefficient and they count on people not following up as part of their business plan. I have an entire department dedicated to following up with insurance companies and we’re doggedly determined and keep all documentation, even most hospitals and doctors aren’t as dedicated as we are about it. We’ve now figured them out and we get paid, but it wasn’t easy. There is no way a lay person could do it as well.
I would contact the office of inspector general for your state and send in a complaint, with documentation. Trust me, no company wants the oig strolling in for an inspection.
UHC deserves a massive dose of Karma. Its hard to believe that their constant strategy of denying/losing/screwing u up/ misprocessing claims is anything but a clearly calculated method of keeping their money in their bank account for as long as possible and hoping people will give up in frustration and not have legit claims paid by the company who is supposed to pay them. After taking 2 years and unbelievable time/energy to get claims for services that were PREAUTHORIZED processed and paid, after many many many calls, letters, appeals, trips to the PO to send registered mail return receipt requested, calls/letters to HR, Insurance commissioner, etc, I resigned from their network. Will NOT deal with them.
I will say, I think one of the reasons we were finally able to get things resolved with UHC is that every time I called, I got the name of the person I spoke to, and would put in each conversation, after they’d told me something would be answered or resolved in a certain amount of time (and I always made sure there was some question they couldn’t answer me that day), “When will _________ happen,” or, “Who can answer this question and when?” And I got direct extensions so I wouldn’t have to go through so many layers of the automated system. And I basically stalked these people. I started talking to supervisors and supervisor’s supervisors. I had email addresses for them and hounded them with emails. I made it such that they hated to hear my voice when I called. Sometimes it was 2-3 times a week.
Teri…no one should have to stalk their health insurance provider to get their bills paid. No one! If this is how UHC operates, no thanks. One of my kids had an issue with them with coverage…It took months to resolve with UHC, and in the meantime, the provider was ready to send the bill to collections. No one needs that crap either.
I’m sorry…but unless I had NO other options, I would NOT choose UHC as an insurer. Sorry…just would not.