United Health Care

I have a concern about the right of consumer. Every consumer has right to give their feedback about the company. How will you feel, when you come to know that your doctors are not happy with your customer service that was delivered by representative in India? Doctors take survey to give their feedback about the service provided by agent and the company but they are not able to connect to survey because survey calls are deactivated when the floor manager realize that customer is not happy and their team is going to get low scores or below 80%. If you don't trust my words, just go for survey. Call for any old claim which has multiple processing or if the amount is withdrawn.or not paid at all, your call will be put on hold for sometime and you will not be able to give feedback at end of the call. Please take very strict action about this. If you really want United Healthcare's goodwill to be improved in America, first do an investigation about my complain then contact me. I will let you know how these malpractices works if you want to retain your customers for long time.

I filed an incorrectly signed form on 10/24/11, so the $437.50 payment would have gone to my provider instead of to me. I refiled immediately on 10/25/11, with a note indicating the error. My provider had received and returned to United Health Care the $437.50 payment by my follow up visit on 11/7/11. Please note that United Health Care had by then, received the claim, processed it, and put this check in my provider's hands, who returned it to them in less than 11 business days. United Health Care issued a second check incorrectly to the provider on 12/2/11. That is to say, having received my correct forms shortly after 10/25/11, and my provider's returned check shortly after 11/7/11, they made the same error, requiring 26 business days to do so. The provider returned this check as well.

I spoke to Christine at United Health Care on 1/19/12 at 8:55 AM, to find out the current status of this October 2011 claim. She said that the correct payment of $437.50 had been issued on 1/17/12 to the insured (myself), and was being sent. She said an additional $125 payment, which had been incorrectly issued to the same provider, was being stopped and correctly paid to the insured. I spoke to Kay at United Health Care on 1/31/12 at 11:23 AM to find out the current status of this October 2011 claim. The particular concern was that I had received payment disbursed on 1/24/12, on a more recent and smaller ($65.33) claim, but not on these larger and earlier claims.

Kay reiterated that the correct payment of $437.50 was issued on 1/17/12 to the insured, and said it had been sent on 1/18/12. She could not explain why a check issued a full business week ago, would have already arrived, except to say repeatedly that her office does not control the postal service. She could not explain the office's mailing procedures, or any other variation in in-house processes that might cause the larger check to be "held". She said the additional $125 payment had been issued on 1/25/12, and mailed 1/26/12. This payment has also not been received. She said the office could not issue a check trace, until the check had been out for 30 or more days.

United Health Care uses mail presort processing, which is evident from the labeling of items received. One possible explanation is that the larger checks to individual subscribers, are allowed to "drop" to the portion of the mailing, which is not expedited through zip code presorting. This will be evident when the check finally arrives. It appears to me that United Health Care has a policy of holding its money from individual policy holders, as long as possible, to maximize its own interest earned. Had I not been following my claims, I probably would never see this money.

I find it remarkable that small sums travel rapidly through the postal service, and large sums take forever, that small sums are quickly processed, and large sums take months, that providers receive reimbursements within 10 calendar days, while I am still waiting for reimbursement after three calendar months. United Health Care is not a proper target of an individual legal action. Unless my experience is unique, their actions would justify investigation by insurance commissioners in multiple states, or a class action suit.

I am looking for retirement insurance and when I called, they asked me for an ID#. I told them I don't have one. I was looking for information and then she asked for my Social Security #. My SS #? Forget it. I don't give this number just to receive information about the insurance for retirement people. The customer service is bad so I changed my mind already after I have read all the bad comments and my welcome to them. Good luck because there is a lot companies with better service.

The insurance company is charging co-payment for generic Lipitor, same as brand name. When I complained about it, I was given a lame excuse of their being the only one generic supplier, and as such, they have to charge more.

I wanted to add another family member (my wife) on to my dental plan. I called and was told that she'd need to fill out an application. OK, fine by me, no problem. Here's the kicker: it will take 7 to 10 days for them to send me the application! What? No email? No, privacy issues. What's the privacy issue related to sending someone a blank sheet of paper? It's just an application!

How 'bout faxing it to me? Yes, we can do that, they said... but that, also, will take 7 to 10 days. What? A fax only takes about 3 minutes! No, no, no, no, they said, it has to go through "processing." Welcome to the technology of the 1960's! My insurance company makes me wait 7 to 10 days before they'll let me add on another family member!

UHC mentions 100% on preventive maintenance but when I went for my annual physical, which the doctor draw blood to check for trigl and cholesterol, they decided that the lab work for cholesterol (lipid) wasn't covered under the 100% preventive maintenance. Only the doctor hearing my heart, touching in my private parts and body but lab work is not covered as preventive, which makes no sense. You have to draw blood and check for possible diseases. According to them, that was changed due to the Health Care Reform law. What a bunch of crap!

UHC failed to provide an EOB in a timely manner. Their performance on the claim is abysmal. They applied tricks to the system to make the claim seem in play when they had no idea what was going on with the international claim. It is still an issue in progress. I actually had a business manager hang the phone up on me. I was irate and unprofessional but I would have thought they would have had better on their side of the line.

The main problem is getting them to pay legitimate claims, and fill mail-order prescriptions properly. As of this writing, they have omitted 6 claims from the December claim summary, that were out-of-pocket claims throughout the year, that were submitted by me and applied to the deductible, totaling $732.14. This changed the total amount of the end-of-year deductible, to be less than it should be. Therefore, I was charged extra for prescriptions that should have been covered 100%.

I was denied full payment of diabetes test strips on September 27, 2011, for an out-of-pocket expense of $540. UHC only applied $289.95 towards the deductible. Two other claims prior to this one, were eventually applied towards the deductible, but not until they made me submit the claims numerous times. After the first denial claim, I followed up with two appeal letters, and they now are requesting me to start all over again. The name of the person who sent me a letter on January 6, 2012, requesting this, is Betsy **, director of customer service. There was no address, and no contact information.

UHC denied payment to Naples Physical Therapy for services rendered, beginning November 1, 2011, because the provider's authorization was not filed on time. I asked UHC if it was an oversight, and if the provider filed right away, would they please allow payment, and they said, yes. Also, payment to Dr. ** on December 21, 2011 was applied to deductible, although the deductible should have been fulfilled, and payment made to the physician. The doctor is owed this money by UHC.

As a result of UHC removing the entries of the claim summary (I have a computer copy of the month before where they were entered properly), it changed how they paid the claims. The month of December was a disaster, when Medco had 3 major problems out of 4 prescriptions. It took me about 20 hours on the phone to get it right. All I want is for UHC to follow their contract, and not deny claims because they hire untrained representatives. They required way too much of my time, to process claims that should have been automatic!

I work for a non-profit organization. We have a contract for speech therapy (92507) through Optum Health for United Healthcare; however, we also provide audiology services. We bill audio claims for out-of-network benefits to UHC. UHC processes those claims as speech therapy claims paying the allowed amount for speech therapy. When I called UHC and spoke to a claims rep, I was told that the claim processed per our fee schedule.

I told them that we're only contracted for speech therapy. They put me on hold to do research and then they came back on the line and agree, the claim was sent back for reprocessing, and then I got a letter back letting me know the claim processed per our contract and no further payment is due. I appeal and get the same response. Somebody tell me, what do I need to do to get them to pay us out-of-network benefits for our audio services?

They without warning stopped paying for a life saving medication that I have been on for 6 years to control my excessive blood clotting disorder. After spending over 5 hours on the phone with them trying to get my prescription filled temporarily while I wait to get it for their "approved vendor", I was told that they would not give the temporary override so that I could get the medication that I need to live and someone will call me later to see if it would be approved. They gave me the run around for over 5 hours to still leave me without the medication instead of just giving the override even though I explained to them that it could cost me my life.

For starters this ordeal has inflicted me unnecessarily. On top of everything else going on in my life I have to worry that I could get a blood clot that kills me because they denied me access to my life saving medication. This has caused me mental anguish and has tremendously increased the stress on my body. They are disgusting. If I die, I am going to make sure that the proper channels know that it was this bureaucratic nonsense that killed me. How do people who have no experience in medicine be able to have absolute control over gravely sick peoples lives?

In summer of 2010 I took a temporary job which provided me with access to United Health care benefits from August 2010 through December 2010 through COBRA (the temp company contracted with another company thereafter for insurance, which I still have). Fall of 2010 through present, I have been disabled with Chronic Regional Pain Syndrome, CRPS. I have been essentially bedridden in pain requiring neurological block procedures and high doses of narcotics. I have relied on family to help care for me and my young daughter. My family and I had not been able to make heads or tails of the plentiful medical reports that have poured in, until now.

Apparently, in the transition from active employee to COBRA status, United Health Care inappropriately denied dozens of my claims, resulting in thousands of dollars in unpaid bills to health care providers. Two bills in particular have been in collections so long that they are now on my credit report. This is a problem, especially as I am in underwriting to refinance my home based on disability income which will terminate next month.

One bill on my credit I did actively try to clear at the time; I had asked the provider to re-bill insurance for one of the bills, but no resolution ensued. The other I was unaware of, United Health Care admits these were insurable bills that they should have paid. UHC has informed me that the fund provided from my prior employer closed 6-11 and the only way they can pay the claims is if I convince my prior employer to re-open and fund the account. Upon my contact with prior employer, they are unwilling to do so.

All my premium payments were timely. In a (recorded with their knowledge) call with UHC, they admit the usual course of business is for UHC to inform prior employer when they 'reinstate' and employee with COBRA and pay open bills. Upon review, many bills were, in fact, readdressed and paid in the fall of 2010.

I have exceeded my out of pocket max. Yet there are many more bills than the two that have shown on my credit report; Dozens of bills worth Thousands of dollars are lurking in cue that should have been paid by UHC. Since they were not, they are are all headed my way through collections. What can I do to get this resolved?! My belief is that my contract is with UCH; and it is their responsibility to ensure funding to support their required benefits. Which party is correct and how can I enforce payment by UHC?

I have called UHC customer service multiple times over the past 1.5 years to get a copy of my bill (that I mailed in to UHC) with no luck. When asked for a reason on why I can't get a copy of my bill, they have answers ranging from security issues, policy issues, no bill available and everything else the agent can think of on that day. I feel cheated because the company will have to pay me if I get a copy of my own bill back. The agent will not transfer me to a manager or promises me that their manager is out and will call back and I never got a call back in the last 1.5 yrs. UHC suck! They are cheats!

I'm not sure why this is relating to a storm or property damage. I didn't select anything regarding that. I am having problems with United Healthcare, Benefit Services, PO Box 221709, Louisville, KY 40252, 866-747-0048. My premium was due on 01/01/12. They printed the billing on 12/22/11 and mailed it out on 12/27/11. I received the billing on 12/30/11. Now they have suspended my benefits. I mailed the payment immediately but of course the post office was closed until yesterday. I do not think it is legal to suspend a customer's benefits until they receive payment when it was their fault. I have always been faithful in remitting my premiums so I think their action is unacceptable. I am concerned about what would happen in case of a medical emergency. Most insurance allows a grace period, but for some reason they do not.

My mother will be 99 at the end of January and suffers from dementia. After two weeks at a rehabilitation recovery facility, they said she was not making progress and they were discontinuing her benefits in three days. I had those three days to file an appeal. I talked with over a dozen people and keep getting different responses. They would not deal with me because there was no power of attorney on file, and though I send in an expedited power of attorney (three times), they still have no record of it.

Her coverage has expired at the rehabilitation unit when in fact patients with dementia take at least two weeks to settle in. I am being told that if she had not gotten supplemental insurance, there would not be an issue. I am contacting an attorney, but I truly feel Secure Horizons is betting my mother will pass away before they have to do anything.

I take pain medication (Lyrica) for severe neurological pain related to a very rare neurological disease. I tried to refill my prescription at my local pharmacy and was denied by United and told I have to use their mail-order pharmacy to get this drug. This was news to me. I need the drug today since I'm out, so they said they could do a one-time override. After waiting on the phone for 15 minutes the Medco rep said they couldn't get Prescription Solutions to answer the phone and wanted to give me the phone number so I could call them. What made them think I could get them to answer the phone if they couldn't?!

And I wanted a Medco/United rep on the phone when I spoke with them. He declined. So, I'm paying out of pocket today for this drug. I don't like using Medco. I switched because they are so slow and difficult when I did use them. My husband called his office and they said they'd never heard of such a requirement. They're checking but I think they'll get the same answer. How can they require me to use them when the service is so poor! I get so upset when somebody screws with my pain meds. They don't understand how bad the pain is and how much I depend on them.

I am writing regarding United's absurd decision to use Prescription Solutions as their primary (and forced) mail order drug pharmacy. My wife's cancer medication has been deemed a "specialty medication" and, therefore, can only be filled by Prescription Solutions. First of all, I find arbitrarily labeling one drug "specialty" versus any other to be both arbitrary as well as discriminatory. United would be more honest to say the drug is too expensive but instead opts for deceptive insurance lingo. Secondly, my residence routinely experiences issues with proper delivery by all package carriers. I have had things delivered to neighbors, left in the bushes, etc.

This is troubling for a pair of mail-order shoes. For a drug that is vital to my wife's health, it is both maddening and horrifying. Never mind that we had a wonderful relationship with our local pharmacist; now any issues have to go through a call center with non-pharmacists. We were not even given a proper option to begin with as to whether or not we would like to use this service. I was told by a United employee that a group of United pharmacists decided it would be better and more trackable to do it this way. This is one of the worst decisions this company has made regarding the treatment of its paying members.

I had failed oral surgery in March 2011, leaving me with my chin on right side of face and 3 branches of trigeminal nerve gone. I cannot move my mouth to left. Too much bone was removed to put me back without making concessions. I had corrective surgery on July 6th, 2011. It was considered an emergency as I could not speak properly, eat, and had no saliva. United Healthcare is denying the claim saying that appeals were not filed properly. However, my oral surgeon sent in the required photos and molds along with paperwork to Debra ** of United Healthcare, which were reason for the appeal.

But she coincidentally claims non-receipt of the molds and photos but received the paperwork. My oral surgeon filed claim with shipping company and received $100 and was told they can't find the package. The entire case is a mess as I will require future surgeries to move my lips, fix atrophied face because of nerve damage, fix septum that should not have been touched. So, I am starting to feel that United is looking at the situation from a legal perspective and is denying the claim, as a result.

After years of debilitating migraines that defied any intervention except for frequent trips to the emergency ward for every kind of shot including morphine multiple times a week, my husband heard of a Dr. *** in Dallas who had controlled many patients with equal or worse situations with electrical implants. His success rate was extremely high and we asked UHC to be allowed to see him. They allowed the trial phase and it was a big success, no headaches even when exposed to known triggers.

We already had the appointment for implanting the permanent materials when UHC just suddenly decided to deny the implants. We had the plane reservations, place to stay, everything and they decided to say it was experimental and would not cover it. Our suspicion was they knew my husband's company was switching carriers after the first of the year so they sandbagged.

We had reached maximum out of pocket earlier in the year due to all of his hospital visits and if the new carrier (Blue Cross/Shield) allows the proceedure in 2012, we likely have to go through the trial again. We had already paid for plane tickets and when we canceled the surgery, it was too late for refund. So nearly $1,000 for the actual flights and the cancelled ones is gone. If Blue Cross allows this, we will have a huge chunk for out of pocket and my husband has a debilitating migraine sometimes up to three times a week. Isn't this what you have insurance for? UHC has all the cards and does not care about the fallout with the patients one damn bit. This is a travesty and there is nothing that will be done to rectify the problem.

We pay insurance premiums to UHC through my wife's employer. UHC says, they are not the primary insurer, and since we are both over 65, Medicare is the primary, and UHC is secondary. For the past 4 years, UHC has told us they were primary, even after we were 65. This is a new review. I think they are trying to avoid fiduciary responsibility. We are paying full insurance for secondary coverage, through the employer. If we change to another insurance company, or take on a supplemental policy at this point, they probably won't cover pre-existing conditions.

I underwent an hernia surgery on September 2, 2011 as my GYN made the determination on August 2, 2011 that I had an hernia and surgery was recommended. My United Healthcare insurance has a pre-existing clause through my company. This policy went into effect May 1, 2011. United Healthcare is refusing to pay any and all of my medical bills as documentation has clearly established this is not a pre-existing condition.

When my daughter was born, my husband contacted UHC from the hospital. They quoted us one amount, but when the money was deducted from our account, it was $100 higher. When we called them, they simply said "oh, we raised your rates." We never even got a letter in the mail. So we asked them how that could happen between the time we sent the signed Rider agreement and the time the money came out and they said "we sent you a letter," which we never received. So we asked them for a copy of the letter. When the letter came in the mail, it was dated for the day of our phone call with them, so clearly, a letter was never previously sent. Still to this day, we pay the higher amount, while we look for new insurance.

My primary care physician, and my surgeon, are both trying to get me into bariatric surgery, to reverse my co-morbidities, which is aggravated by my severe morbid obesity. These conditions are, hypertension, hypothyroidism, sleep apnea, insulin resistance, DVT in the past, to name a few. These conditions are supposed to be covered by UHC, however, there is an exclusion in my policy, which reads that obesity treatment, including obesity surgery are excluded.

The RNY surgery that is recommended, although it is listed as a obesity surgery, is also a treatment for the morbidities I am experiencing, and is deemed medically necessary. Because of the exclusion in my UHC policy, UHC will not cover this surgery. The co-morbidities that I am experiencing can worsen, at the least, and can be fatal.

This company does everything within their power to deny necessary authorizations including arguing with doctors about their patients' care! These retired consultants from United Healthcare aren't even up to date on most medical findings. Their mission statement is a joke! I'm sure someone is getting a bonus for their denials because I've heard it happening to many people including myself! It's time the insurance commissioners take a look at this company.

This company lies about claims, transfers you over and over again, and doesn't keep track of their gap coverage, which is a joke. I have spent over three hours on hold so far and have not been able to get any clear answers about why I am not having my claims processed in a timely fashion or done properly.

I have been experiencing denials of Claims for missing NPI number, that is clearly shown in the appropriate box. This has been going on every month for over 3 years. Each time I contact the company, I am told it is a computer glitch, and the number does not show up when the form is transferred to them. This allows them to withhold payment for an additional 30 days. Frankly, I am exploring the possibility of suing the company for acting in bad faith. Has this happened to you?

Without notice, UHC dropped two of our children, claiming they had another provider. Now, UHC has dropped my daughters, a twin, from the vision plan without reason. There has never been any contact from UHC to explain the changes or that they had occurred.

After discovering we were being denied coverage, a call was made and the children were reinstated for healthcare, but not vision. Nobody at UHC has any documentation why this is happening.

My husband and I tried acquiring health insurance through our agent and I considered United Health Care a great company, so we put in an application. We rarely, if ever, get sick. We received a letter in the mail from UHC and I was declined because of my height and weight ratio; not because of my health history.

I consider this discrimination against people of size. It is no wonder that so many people in this country don't have health insurance.

UHC/NHP are denying to reimburse me for the cancer surgery because I was in the process of going into COBRA and I was not on their system whenever the doctor/health center called them. Authorization was impossible to get when they had no record of me, but I was in the process of being COBRA'ed and I am in it still now.

I have been receiving a bill from a medical provider since January 2011 for services received on December 2010. I have called and spoke with the service provider who states UHC has not paid the bill; however, every time I call UHC, I have to speak to a different person and describe the whole situation all over again. UHC has given me many excuses such as, "We paid it," "We asked for a refund but we have still paid it," and "We don't know why they are billing you."

I have been told that the service provider has been sent a letter to stop billing me, that it will be taken care of, and that I am not responsible for any of the charges by every person I spoke to on the phone at UHC. Now, I get a letter saying my bill has been sent to collections for lack of payment. Again, I call UHC and talk to yet another customer service representative who knows nothing about the situation. She kept me on hold over an hour to call the service provider in order to find out what happened with the payment. Then she tells me, "I have to call them back tomorrow morning to get more information." She says, "I will call you at 10 am Central Time tomorrow to tell you what is going to be done about this situation."

At 10 am the next morning, there was no phone call at all. I call the service provider at 4 pm and she remembers talking to UHC about the situation and says, "They were supposed to call me this morning to get a file number, but they never called me back." Again, I called UHC and talked to a new customer service representative who says, "Systems are down. Will you call back in 30 minutes?"

I have never been treated so poorly by a company, and now, my 800+ credit rating is about to be ruined because UHC did not pay a $300 bill that they were responsible for, and they admitted to me every time I spoke to them that they were responsible for it. What's worse is that after 9 months of calling and asking for it to get taken care of, nobody there seems to know why I am still getting billed and why it hasn't been paid. Nobody can give me any answers.

What else can I do?

UHC has declined to cover medical care for PKU. By declining to cover medical care for PKU, United Health Care is in violation of Minnesota Statute 62a.26. I have health care coverage from United Health Care (UHC) for my son. My son has phenylketonuria (PKU), which is a genetic metabolic disorder. The healthcare policy clearly states that the PKU care is covered by the plan. I've provided them with all the information they've requested, including a Statement of Medical Need from Cruz's doctor at the University of Minnesota Clinic for Metabolic Disorders.

I have submitted a claim for a covered expense reimbursement (hearing aids). The claim was dated May 25, 2011 and the reimbursement was submitted June 8, 2011. I have called them at least 10 different times and each time they either claim they didn't received it or it's under review. They denied the claim on August 4, 2001 and I appealed it on September 2, 2011. It's been more than 4 months. They are contractually obligated to reimburse $600 of the $2,750 in costs. I think they are stalling or postponing payment of the claim to benefit their cash flow. I would like the DOI to intervene and contact them or me.

I have United Health Care insurance through my work. I signed up for the "100% paid preventive colonoscopy". I received my final paper work from the hospital with the 3-4 potential charges that will occur. Luckily, I really read it and found out that they will not code the procedure until after they do it. If they found one polyp that puts the 100% preventive into a medical status, the payment would be needed in full.

United Healthcare had previously explained that they had a software problem with the first mistake on cost to us and would correct it. A month later, same mistake, same excuse. Today, I spent 2 hours on the phone about an error on their part (claiming a doughnut hole when my plan does not have one). First, the representative went off to find an answer and 15 minutes later, they hang up on me. Second representative took another 20-30 minutes or so, came back and started to explain but got cut off. Third representative called their Pharmacy Desk who had to call Prescription Solutions (another bunch of **) and I gave up after another long wait.

I have been receiving MD bills for procedures, labs, and MD visits for my spouse and I. Per United Health Group, we have $550 in our HRA (reserve account). This also shows on the computer. I have called 8 times (I have the dates and people I talked with, if needed).

The first time, I was told that it should have been paid and assured me it would be paid in 10 days. The second time, the excuse was it takes time due to the holidays. Now, it is no one knows why the bills are not getting paid but they are looking into it.

This has been going on since the bill in May of 2011. I have been transferred many times from customer service to the resolution team, and even a supervisor. All say they do not know what is wrong, but they are working on it.

At one time, I was told to pay them then the medical offices will pay me back when United pays them!

My son was to go in for a scheduled reversal of his ileostomy which he had approximately 3 months prior at a pediatric facility here in Fort Worth, TX. The facility was not in network for HCA, the company my insurance is through. The closest pediatric facility is located in Dallas, TX which is well over the specified distance required under my plan. Cook Children's Hospital is in network under United Healthcare but we have to have special approval to use the facility unless it is an emergency, which at that time we can go and then all the required authorization is done after treatment has occurred.

Anyway, my son's doctor's office notified the insurance company in advance and the pre-authorization was given to go ahead with the surgery as well as the hospital above. Now, I am getting denied for the claim because we did not utilize an HCA facility even though we were given authorization to go ahead and use Cook Children's. This is not the first time he has utilized Cook Children's, he had at least 6 admissions this year alone and they were paid on all of these admissions. To make matters even more ridiculous, the surgeon and the anesthesiologist filed their claim to United Healthcare and both were paid in full for the denied hospitilization claim.

Although both doctors are on United Healthcare's list, neither doctors are on staff at any of the HCA facilities in my area. I have contacted United Healthcare three times already and they have the authorization numbers in the computer, which they have read back to me confirming what Cook Children's have on file as well, and still are denying the claim! I am now starting the long appeals process, which I feel is totally unnecessary. What recourse do I have as a consumer? Can I take legal action against United Healthcare since I was given the "okay" for my son to have surgery, then now denying the claim.

I have been trying to be reimbursed for an out-of-pocket expense through a network provider with United Healthcare Secure Horizons doctor. I have tried since October of 2010 until today. I have tried three times to appeal the denial letters by sending them proof of payment, the doctors bill, and the claim form given to be filled out. I am now going to have to start a legal action because they do not want to pay a person their due. I am also filing a complaint with the government who investigates insurance fraud. Please do not believe anyone blindly, they will ** you every time. I have a degree in the ** you club.

I used to have coverage with United Health Insurance with my employer and due to not enough participation (less than 50%), the policy was cancelled.

Then I applied for individual coverage with United Healthcare Golden Rule and due to the fact that I took (in 2006) high blood pressure medication, they denied coverage. This is ridiculous. While I was paying, everything was fine and they covered all of the treatment under my employer's policy. But now that I want medical coverage, they do not want to cover me.

How come if "the condition" is what is making them not to cover me, "the nurses" or preventive health call me to try to assist me with the such "medical condition"? I was under the impression that under Obama's new law, nobody was going to be denied for insurance coverage due to pre-existing condition. I am not afraid of not having coverage because TG I don't need to go to any doctor. My concern is that if I have an accident or any issues in the future, that I will end with an unbelievable hospital bill.

I went to fill a needed prescription and I was informed by my pharmacist that United Healthcare no longer covered this medication. This is a medication that I have been on for several years. The last two to three years, United Healthcare has covered this medication. Now suddenly they, with no correspondence or warning to me, have decided they will not cover it. There was no warning and no reason. Well, isn't that nice that they can decide whenever they want to not cover an expensive prescription and provide no reason.

The medication helps to keep my hormones in balance. Abruptly stopping the medication has left me irritable and lethargic. It does nothing for the irritability that I have tried to get a prescription for a similar medicine, that did not work as well, and have been unable to actually talk with a person.

Now I have been without the medication for a week and finally I talked with someone at the pharmacy and I was told to go through and they said that they can send me a form to fill out and mail back and I could expect the form to arrive in 8-11 days. I asked for a website to print the form to facilitate this a bit more quickly and when I went to the website provided, it was not operational. So I wonder if I am cranky from dealing with this company and it's representatives or am I cranky from lack of medication? I can't say for sure who is to blame, or both, but I can say that I am extremely tired all the time and that is another risk of abruptly stopping the medication. This is a horrible company and I can't believe that they can do this to anyone.

I was with Unison aB for several years and they always paid for all my diagnostic tests. Just shortly before the program was cancelled, it became United Health Care, and I received a letter from them saying that all the same services will still be provided. Well my pcp sent me for a cardiac ultrasound and unbeknownst at the time to me, United refused Pinnacle Health to cover this diagnostic test. I wrote to United health care twice, and as instructed by one of the staff to address it to correspondence team. I never received a response back.

During this time, Pinnacle Health turned over the bill to a collection agency, which has been constantly calling me. United knew the adult basic program was ending, so I believe they just didn't want to pay the claim.

The bill is for $1,089.00 and this amount is equivalent to about three years of monthly premiums to me under that program and I was on a waiting list to get into that program, which is gone now.

I was admitted to the emergency room for severe abdominal pain on November 5, 2010. UnitedHealthcare is my primary insurance. They refused to pay my $6000 hospital bill. At first they wanted records from all of my medical providers. This lasted about seven months. Then, after all the records were sent in, they denied coverage stating that it was a "pre-existing condition." It was not. I then successfully appealed.

Now they had rejected coverage because I had secondary catastrophic health insurance through my law school, who never even responded to the claim when the hospital filed. This was Maksin Management Corporation. This insurance plan will not pay if you are covered with another insurance company. Both insurance companies will do anything to ignore and deny these claims. I think maybe I should just go ahead and sue. I have been fighting with UHC for nine months. I am beyond fed up.

Hello Due to past mini strokes , if word typed incorrectly please forgive me .I have had I can take from this former employer. I had to fight to get disability short term and long term ...although I had been ill and taken from the co by ambulance more than 6 times in the last 3 years .. I finaly had to do all the legwork myself although i can barley use my right side at this time ...now they let me go i had paper work faxed to them for cobra ...they now claim this was never received .. this part with cobra issue has gone on since 4/30/11

I no longer find it shocking the lengths that insurance companies will go to deny claims; I find it numbing.

Today, Mike was denied his appeal for double dose Cimzia from United Health Care. The reasoning was that medication is used at a dosage determined by us to be experimental, investigational, or unproven. If we do not experiment, investigate and try to prove then we become less than sloths in our society. The case was determined by a pharmacist for the insurance company instead of a Licensed MD. The letter was written to Mike with a tone implying he had decided to up the dosage of his meds. Not mentioning the specialists whom have requested the dosage increased. They did c.c. the Miami specialist.

Mike lives his life in a Crohns Flare regardless what meds he is on. He is on the toilet more times before 8am than some of us go in a week. That is just the first round of the day. He is a sick man who constantly has to fight the system because of his illnesses which of course makes his overall health worse.

I am disgusted in our system. It sickens me that our government let sick people go without medications, procedures, and funds at the hands of the insurance giants that rule the lives of unhealthy people paying them a monthly premium. We have been left with our hands tied because of ERISA. Our government refusing to change these laws proves even more the stronghold insurance companies have over them. So, here we are again. Another insurance company that we are paying controlling Mike's health, or lack of.

Luckily he has a great staff (yeah staff, that is what it takes to try and control his illnesses) scrambling around trying to find a medication so he won't die. That is not drama, that is the truth, just ask Dr. **. He is from South Africa and still cannot fathom how when he writes a script, it is not honored. Or ask Dr. ** down in Miami. He has his staff trying to find an alternate for Mike. Or you can ask Dr. **, she is meeting us on Tuesday, trying to find Mike something to not let him fall into a depression. Or ask any one of the nurses who have been so kind to Mike. They all say our insurance system sucks.

My name is Carol **. I am the mother and advocate of Ezekiel **. Ezekiel is a 10-year-old boy who suffers from severe epilepsy (gas-taut syndrome) and cerebral palsy. Ezekiel was home bound in February 2008 due to his worsening condition. In February 2008, I had to resign from my job and stay at home to care for Ezekiel full time. Since then, I have been struggling with United Health Care (provided by my husband's job) to approve a much need medical bed for Ezekiel. I have provided pictures of the crib he currently sleeps in and pictures of bruising that he has encountered because he has outgrown his crib.

The battle is still on going with United Health Care. We have been denied this claim three times because they feel it is not medically necessary. I have worked closely with all of Ezekiel's doctors and provided the information UHC has requested. It has been proved over and over that this bed is medically necessary for Ezekiel's needs, growth and safety.

In 2010, after a year of pulling for my son's medical bed, UHC denied the claim once more. At the beginning of 2011, I placed a claim myself with the help of my son's pediatrician. We have spent a significant amount of time collaborating and providing UHC the information needed to finalize this claim. On 5/18/2011, I was told by UHC that they have no record of the claim or any information on Ezekiel's file regarding the most recent request for the medical bed. My son's pediatrician was contacted by UHC last night and she had to place the claim all over again. Meanwhile, my son is sleeping in a crib that is too small for him and risking getting hurt and/or breaking a limb.

I don't know if I am contacting the right person for help. But I beg of you, on behalf of my son. Please help me. If you are not the correct person, please forward this email to someone who can lend a hand and help me resolve this unfair situation. Thank you for your time.

There were 2 procedures performed on my spine. For the first procedure, the claim was denied and not paid. The second one, however, was paid. These were identical procedures. United Healthcare has given me every excuse why they haven't paid. I complied in getting all of the information that they needed so that they will pay for it. From having my doctor recode and re-bill the procedure, to faxing them my 36 page medical record, which they say they don't have.

This is a huge HIPPA violation. They have made a final decision to not pay for the procedure that allowed me to be able to walk again. United Healthcare also said it wasn't a necessary procedure, which I am left to interpret that my being able to walk is not necessary.

I have life insurance on my husband that is auto deducted from a checking acct. There is no clear name or phone number only a company ID number. Would you know how I can find out the actual name of this company by its ID #? It is ******. It also says United/Drs I need to find them or they will take a payment again and the account is closed. Can you please help?

I have had SecureHorizons's high-option dental plan for many years. Recently, I developed a serious tooth infection and needed immediate treatment. When the dentist called SecureHorizons to refer me to a specialist. He was told that I was switched to an economy plan and wasn't covered. I then called their customer service and told them that I never switched dental plans and reminded them that according to my bank statement, they were still debiting my account for the high-option dental plan.

It was obviously an error on their part, and they refused to admit their mistake even though I have documented proof that I never changed from the original plan. When I asked to speak to a supervisor, they refused. When I asked for the address of the corporate office, they also refused. It's as if I were talking to mindless mechanical trolls.

Their customer service representatives will not let you talk to anyone else but their selves and will not give you any information, for you to have any recourse. it's as if we are dealing with criminals that have set up an organization that wishes to operate undercover.

This is sad, and I urge everyone out there, that before you join any health organization, to first inquire as to the physical location of their corporate offices, and if they give you excuses, then try another health care provider. I do not recommend "UnitedHealthcare" DBA Secure Horizons/AARP

When we first joined AARP/Secure Horizons/United Healthcare, we opted for the complete package including gym facilities and dental insurance. We selected our own dentist from their list, only to find that our dentist no longer was affiliated with them nor had been for two years. We immediately contacted them and asked to be put on the healthcare only, to drop the Plus and Hi Dental coverage. We received new cards indicating dental and Plus were no longer available to us.

All seemed fine. That was 2009-2010. Now, we are getting billed for my husband's Plus program saying he never paid his monthly dues of $11.00 x 12. We have the cards indicating he was no longer a Plus member and a letter indicating that they had received his request to cancel Plus. Still, they bill and say we owe the $132.00. Ironically, they do not say I owe them for the Plus program. You cannot talk to billing directly, customer service is not allowed to return calls even when they say they will.

Their system is impregnable. It is like trying to get information through the Iron Curtain. We are tired of trying to get this straightened out. No one at AARP/United Healthcare/Secure Horizons seems to talk to other departments and we are beginning to think that this is a carefully planned tactic; that you will get tired of trying to straighten things out and end up paying. We are not going to do this. We will keep fighting it.

Insurance United HealthCare attempted to force me to fulfill my insulin dependent son's insulin pump and supplies under DME portion of the policy when my policy allowed for third party pharmacy fulfillment from Medtronics through UHC Rx mail order partner, Medco. Through DME, durable medical eqp, I have an annual cap of $2500, so my copay for the pump alone would be over $4000.

I argued my case, and setup calls with managers at Medtronics and my local representative, Peter ** and we kept pressure on UHC. Finally in March, just before Medtronics lost their in network relationship through UHC ending it, the pump was fulfilled under the Rx program. And to boot, Medtronics was put back on the network. Now, UHC is denying my surgery with my surgeon, again bullying by dropping my surgeon from network, not responding to his inquiries why and telling me I can't use him for the surgery scheduled in less than two weeks from now.

I am just out of a 4-day hospitalization, all pre-ops are completed, and UHC is demanding I see the doctor of their choice. They actually gave me the name of the doctor, who is miles from me, not affiliated with any hospital near me, and I have to start over with an initial consult when I have had 18 months of history with my surgeon on this condition and I have secondary conditions that warrant my staying with the original surgeon. I requested continuity of care, denied, then a clinical gap extension, denied again. I have anxiety issues and am treated for them. I am unable to take on another round of doctors and tests. I have been hospitalized emergency with this condition over and over, and it is costing UHC more on the hospitalization no surgery than to just let me complete with my surgeon now.

Calling UHC, I am on the phone for hours, bounced from one person reading a script to another. I have enough apologies from the sorry customer service staffers to make me the richest person in the world (each apology worth 25 cents and I'd still be richer than Bill Gates), but these representatives are not able to answer real issues, handle emergencies or do more than basic call handling. I was on the phone this morning over two hours just to find the decision on the gap extension.

I am filing complaints with the NY State Attorney General, the Attorney General for the two major offices, Minnesota and Utah, as well. Perhaps Andrew ** would like another go round with UHC before he leaves the AG office for the Governorship.

I am an emotional wreck and will be seeking treatment for anxiety. This makes the acid reflux / hernia worse, which is the condition that was so bad during the last hospitalization that the doctors chose to not remove the gall bladder until they could get the acid under control. I still do not know how well my thyroid is responding to the new synthroid level, and I am sure the stress of dealing with UHC, who at best is incompetent as an entity, and in my experience, the big bully on the insurance block, is definitely making me physically sick.

I have instructions for my son, should anything go wrong with this condition, to seek financial compensation from UHC for consistently delaying needed treatments through their incompetence and intentionally through their cumbersome and messy requests / appeal process.

I had health insurance coverage under UHC/COBRA. I had some difficulties to make the payments and my insurance was cancelled. I asked for some insurance options which they said have Golden Rule; but at the time I called to complete an application for health insurance coverage I was informed I didn't qualify due to my weight and height. I was like, "What? That's insane." I never heard an insurance company deny you for weight and height. What type of insurance is this? I will never recommend United Health Care for nothing. It's too bad to feel and think this way because in my years with UHC I never had a problem until now. Sorry UHC, you lost another customer!

I have been trying to call AARP all day. It's a 10-minute to 30-minute wait like people have nothing else to do. I don't know if they don't have enough people to answer the phones or if their people are just goofing off. The government needs to do something about this company. They deliver no service whatsoever. I am a recent widow and received a payment book of some kind in the mail with no letter of explanation. I wanted some simple answers. Instead, I'm now writing this letter at 9:00 PM and getting so stressed I'm having shortness of breath instead of relaxing with my favorite TV show. I am so aggravated I could and am screaming!

Now, I want to change my supplement insurance and find that I only have until December 31 to decide. I never handled any of this stuff before and suddenly I'm on the short end of this mess and this company is making it worse. I don't want to have anything to do with any other thing that has AARP attached to its name. My husband quit their regular AARP subscription a year ago and now I understand why. They have completely gone downhill. I don't understand why United Healthcare allows them to handle anything for them.

On September 16, 2010, I went to collect my long-acting pain medicine. When the pharmacy rang my medicine up on checkout, she stated to me that this medicine was $309.82! I asked her why it was so expensive. She said that she didn't know why but she would be willing to call to find out. I had been receiving this very medicine for the better part of a year and I was completely shocked when my pharmacist told me what United Health to her. United Health Care RX told my pharmacist that as of the day before, 9/15/2010, that they would not be covering my long-acting pain medicine.

I could not believe this! No warning letter for United, no any kind of letter. At this point, I had to ask a relative to pay the $309.00. I didn't have that kind of money! I live on SSD and my total income is $900.00 per month! My relative paid for the prescription and my pharmacist told me that United told her I needed a formulary exception. Come October, nothing had come through as a formulary exception. My doctor had to write a different medicine for me. The problem was I could not take any of the other types of long-acting medicines. I ended up the next two months into withdrawals and only with one sort acting pain medicine! I became suicidal. I didn't have enough pain medicine, enough time to plan for such an even and now had gone through the sort acting medicine within two week.

I have a serious chronic illness and being shoved into withdrawals on top of that. I was violently sick, having horrible pain and trying to find out what I had to do to get my medicine back. I did not get any help until November and truly not sorted out until 12/1/2010. I did finally get my long-acting medicine under a formulary exception but here's another kicker. United did not post date the formulary exception to retro-pay the September amount of $309.00! It wasn't bad enough that I nearly committed suicide, was violently ill from withdrawals I had more than 2 months of pain and suffering, and never being sent a letter to advise me of any changes but now I wasn't even going to be able to pay my relative back! United stated it was my fault that I didn't ask my doctor to request coverage backdated to 9/16/2010 Like I'm supposed know that! And isn't it strange that the day United stopped paying was the day the new health care laws were enacted!

This company is nothing but criminals! Their staff were rude and horrid to me. I spend over 4 hours trying to get the truth from them and just this week United Health care RX/Prescription Solutions sent me a booklet so I could pay them every month an extra $1.10 on top of what medicare pays them! I have now changed who I will be getting my prescription coverage from. And I hope some attorney reads all these complains. Because this company nearly committed murder! And my family nearly lost their mother and daughter due to a company that is playing politics, giving no zero warning concerning coverage, making people sit on the phone for hours and then not paying back $309.00 they owe as retro coverage! How was I suppose deal with this situation without warning Shame!

My husband was diagnosed with an incurable cancer in September of 2010. He's employed with International Paper and has coverage with United Healthcare. We've never had problems with United until the past 2-3 weeks. International Paper has opted to not renew their insurance with United Healthcare in 2011. I am beginning to think the rudeness of some of the employees and failure to pay for certain things (big dollar) is due to it being the end of the year.

My husband's oncologist firmly requested an MRI with contrast. We arrived at the hospital today and were denied the MRI as United Healthcare didn't want to pay until his oncologist spoke with one of their doctors. Now, United has agreed to pay for the MRI, but has refused the MRI with contrast. This is quite disturbing especially with him having Multiple Myeloma.

I truly feel it's revenge for International Paper not renewing with them. Any suggestions? Our premiums are always paid in full! I would like to know why they denied this and want them to pay in full for an MRI with contrast.

I am not sure what, if any damage, this may cause down the line but I do know that the doctor wouldn't have requested this if it was not what he felt was needed.

I am a Federal employee. During 2009 and 2010, I enrolled in the Consumer Driven Health Plan (CDHP) offered by United Healthcare (UHC). A key feature of the plan was an annual $2,500 deposit into a Health Reimbursement Account (HRA), which I am entitled to use for eligible medical expenses as long as I am enrolled in the plan. Recently, UHC made the business decision to no longer offer the CDHP to Federal employees beginning in 2011. As a result, $4,258.55 of the $5,000 that had been credited to my HRA will be forfeited to UHC in early 2011 and will no longer be available to reimburse me for future medical expenses.

Since the forfeiture of $4,258.55 resulted from the actions of UHC and not because of my voluntary withdrawal from the plan, I feel that UHC either used the fraudulent inducement of a revolving HRA to convince me (and many others) to sign up for this particular health plan and that UHC would be unjustly enriched if it were allowed to keep this money. Since there are undoubtedly many others in my position, this issue could possibly form the basis of a class action case against UHC.

I have been billing insurance for doctors for over 30 years and have never in all this time dealt with a company as bad as United Health Care. They pull every text book trick that I have been trained to look out for and still I continue to have claims denied for every patient we see. I would advise anyone out there to not choose this company no matter how good they make your premiums look. They do not pay. Their customer service is the worse. Doctor's offices have to talk to someone in India, very hard to understand. The authorization process is impossible and claims are never paid on time. This company plays more games than I have ever seen. Consumer beware you will end up with the doctor bill if you choose this insurance.

I recently retired this past July 2010. I elected the health insurance that my company offered it's retirees. The cost was $313 a month for medical and prescription. Just got a letter effective 1/1/2011, the cost will be $449 monthly.

That's a 43.5% increase. I receive SS benefits (age 64) and a small pension from my company. Have a mortgage and a 17 yr old daughter who wants to go to medical school. How are people suppose to manage? And there's no cost of leaving in 2011 for retirees. This isn't the change people were hoping for.

I was amazed when I received a bill from my children's pediatrician. I have two boys ages 15 and 12 and one girl age 10. During their annual physicals, Dr. Moskowitz, New Providence, NJ advised that the children receive the Gardasil vaccine, which consists of a series of 3 injections. All 3 children received the first injection and 2 weeks later, I received a bill for $360.00 because United HealthCare refused to pay for the boys. Each injection is $180.00 per child. The doc's office contacted Merck, the manufacturer of the vaccine and United Healthcare. They continue to refuse to pay. I don't understand why other insurance companies are paying for both girls and boys, yet United Health refuses. Is this discrimination? And who should be responsible for the bill?

In addition, the boys will not be fully protected by the HP virus. I wanted to get the word out and ask for your help from you other parents that should be made aware of this issue. Please help me get the word out.

So who wouldn't think the call was necessary?

I talked to my independent insurance agent who told me she has received several calls like mine. She says, after making the call to confirm the "mistake," her clients were offered other plans for the coming year. I'm in the business of advertising and marketing on the Web and still have my clarity of mind. Even so, I almost paid the invoice! I believe many other seniors on Medicare are likely to be fooled by this letter. In my business, this letter is considered a scam! Secure Horizons "unintended consequences" is not a legitimate excuse.

Any honest information technology system designer would have excluded me from the list of folks losing the defunct plan and would not have had to put the disclaimer "unless....." in the letter. I should not have received this letter! What's wrong with this picture? We must prosecute insurance companies who "do harm."

They doubled the triple billed for one payment, causing my account to go negative and accumulate fees for NSF. I asked to have the director call me and no one has; started 10/05/2010 and now still waiting on 10/14/2010.

I've spent endless hours on hold, talking to representatives, supervisors, faxing from bank verifying unauthorized drafts, etc. No satisfaction and now they referred me to United Health! This is unconscionable and they told me many customers are involved; their computer has gone haywire, out of control and they are not treating this as an emergency as it is and told me I would have to wait 15 business days while the bank fees are processed, but the bank fees would continue to accumulate, and now I am unable to make the next payment.

I know that government does not care about the average citizen but my complaints to my health insurance company and the State of New Jersey Insurance Commission have gone unresolved and I am out of places to turn to. As of October 1, 2010, United Healthcare (Oxford Division) has informed my that due to "Health Care Reform" my insurance premiums will rise an additional $767.78/month over our current premium of $1389.39 per month, a staggering 55.26%! My husband and I own and operate a small business, this policy covers us and our son, and there is simply no way we can afford it.

Unfortunately, my family and I will become a casualty of Health Care Reform instead of a beneficiary and will probably be seeking public assistance to provide our medical care needs. It is too bad that the only stories of Health Care Reform that make the news are the ones of success, not of the plight of that average working class American Citizen.

My dentist suggested a space maintainer for my son because there was not enough room for his permanent teeth that were coming in. The dentist called our insurance company, United Health Care/Dental, and was told a space maintainer was considered "preventative" and was covered 100%. I also called and was told the space maintainer was covered 100%.

I went to their website and it said that the space maintainer was covered 100% with an in or out of network provider. Therefore, I was very surprised when the dentist told me the claim for the space maintainer was denied and that even if it was not denied they would only pay $237 of the $1200 the space maintainer cost. When I called the insurance company and finally talked to a manager, he said they cover 100% of the allotted amount. How can they get away with being so deceptive? Now that the space maintainer is already in his mouth, somebody is going to have to pay for it! I am responsible for paying for a $1200 space maintainer that was supposed to be covered 100% by the insurance company. Not until I spent an hour and a half on the phone being transferred back and forth from UHC and Golden Rule did I find out they paid 100% of the allotted amount.

Several months ago, I was diagnosed a voice disorder called Spasmodic Dysphonia. I have been working for the same company for over 22 years now in the mental Health field. It requires me to be very verbal and active. Due to my illness, I am unable to do much talking and when I do I become extremely fatigued due to the involuntary spaziums of my vocal chords.

I have been out of work on medical leave for 10 weeks now due to this. I have been awaiting approval of speech therapy for over a month now. I have been on the phone with UHC every day now for over a month, and every day it's the 3 same excuses. I haven't had a stroke or of the autistic spectrum. They say the doctor needs to fax a pre-authorization Letter to the predetermination department stating that it's a necessary treatment. Finally which happens constantly that I am told to hold while they transfer me to the correct department and the call suddenly is dropped. Am I am disconnected?

My Physician's office has faxed a pre-authorization letter to the pre-determination department at UHC 4 times now and for each time has received a confirmation page that it went through. I have been paying into my health insurance there for over 20 years and I should not have to feel so unjustly burdened. If I don't receive the therapy I need, I could eventually become mute and permanently disabled. Quite frankly, I'm afraid. I will never be able to return to the job I know and love for the last 2 decades, and I am becoming a burden on my three small children. Every one gets hurt in this. I'm sick of feeling lied to, I sick of being hung up on. I just want to get better and return to my normal life. I'm begging somebody out there please help me! Thanks.

Bloodwork bill over $200 was not paid because it was negative! I was told if it were positive it would have been paid. Unfortunately unable to predict future except that UHC will refuse more payments!

I respectfully submit a request to appeal your decision to deny a claim made by UPMC Physician Services for the Service date of 3/1/2010 for Radiology services for a charge of $165. This service was provided at an in-network hospital, St. Margaret's. It was ordered by an in-network doctor. It was performed at his same hospital in preparation for surgery. All research indicates that it is both unsafe, and not best-practice to perform this particular surgery without first performing this X-ray.

I checked the UHC website prior to service to be sure that the hospital and the doctor were both in-network. Then I called the UHC phone help line to notify you that I would be having this surgery, and to double check that all charges would be covered in-network. I asked specifically about this x-ray, because I knew it had to be performed in order to proceed with the surgery. I was told by the United Healthcare rep that it should be covered, as it was scheduled to be performed at an in-network hospital and ordered by an in-network doctor.

Apparently the Radiologist who read the x-ray, whom I never saw, apparently is not an in-network physician. I was never told this nor consulted about this, nor was I notified of this at any time. I would not have any way of knowing that the x-ray that was taken at this in-network hospital would have been read by a doctor who was out-of-network doctor. Nor did I have any cause to reasonably suspect that any services that were provided to me at the in-network hospital would possibly be rendered by someone outside of the hospital, or outside of my network. I believe that I acted in good faith and made every possible effort to investigate whether all charges would be covered prior to surgery.

I chose this doctor and hospital specifically because they were in-network, even though two other out-of-network doctors had been recommended to me. I did this because I cannot afford to pay more than my insurance will cover. Please reconsider your decision in my favor, and reimburse for this service.

I appealed a determination for unpaid medical bills from 10-2009. I received a letter dated 12-21-09 stating a portion of the bill would be paid. I appealed their decision by letter. United Health Care acknowledged the receipt of appeal on letterhead dated 1-21-10 within the 60-day window, but I never received a denial.

United Healthcare / Medco will do everything in their power to get more money from their consumers. Today I went to pick up my Effexor XR that I have taken for 12 years to find out the pharmacy hadn't filled it because United Healthcare / Medco had determined that I should switch to Welbutrin. This seems like a serious ethical issue since Effexor XR is a behavioral medication that has been working for my depression for 12 years.

I was informed by the customer "service" representative that all the pharmacy was doing was passing along the message from my insurance that there was a cheaper option. Welbutrin and Effexor are not the same drug!

Then I found out the reason for this is the newly put on the market generic version of Effexor is a Tier three drug and requires a co-pay of 35.00 as compared to my normal copay of 20.00. Get this, the name brand drug Effexor XR has a lower copay than the generic so they requested my pharmacist to switch to the generic. Now I am paying more for a less expensive drug!

I asked them, if they had my best interest in mind (which they continually have told me), why they would not have recommended the Pharmacy stay with the Effexor XR? The response was "we don't control the messages that go to the Pharmacy. "

So here's the recap:

1. They decided they were doctors and should try to convince me (or the Pharmacy) to switch from one depression medication that has been working for me for years to another medication I have no experience with.

2. They are charging me more of a copay for a less expensive generic drug (so the total cost to them drops even further)

3. They don't want me to take the Effexor XR because it has a lower copay and costs them more.

None of the reasons above consider what is best for me as the patient. I realize that insurance is a business, but it sickens me that they would take a chance of changing a med that I am stable on for one that makes them richer!

In this first year, I purchased two generic (Tier 1) prescriptions through their affiliated mail-order PBM, Prescription Solutions. When I paid for these, the payment was credited toward satisfaction of the deductible as well as payment for the two prescriptions.

I then purchased a Tier 2 brand-name prescription. The charge for this prescription consisted of the balance of my deductible plus the full cost of the prescription. Since I had now satisfied the entire deductible, the full cost was calculated at the Initial Coverage price. In other words, the money that I paid to satisfy the remaining deductible was not credited toward the cost of the Tier 2 drug but was simply treated as a surcharge or additional premium.

I calculated that this practice resulted in an overcharge of about $37.00. I stopped payment through my credit card company and began the arduous procedure of appealing my complaint through Medicare.

My credit card company eventually credited me for this overcharge. At this point my Medicare appeal had reached the level of the Part D Quality Improvement Contractor (Maximus Federal Services) who denied my claim. Since I had already received satisfaction through my credit card company, I did not press my appeal any further. However, I did notify the Medicare Fraud and Abuse Contractor about this problem. They pointed out to me that the the Center for Medicare and Medicaid Services does not spell out in their regulations how the deductible is to be handled; only that a deductible of up to $310 is allowed.

This year, I made the same purchases and again, the same billing practice was used by Unitedhealthcare/Prescription Solutions in handling the deductible. Due to slight changes in cost structure for 2010, the overcharge was about $33.00. Once again, I complained to my credit card company and started a new adventure with the Medicare Appeals process. This was a different credit card company and it apparently lacked the aggressiveness of the company I used last year. The result was that I was not given credit for the overcharge.

As for my Medicare appeal, it has been denied through the level of the QIC and I have appealed my claim to the Administrative Law Judge. Despite the low dollar amount, it has been accepted by the ALJ and a hearing is scheduled for August 4, 2010. I have to admit that I am receiving a certain amount of satisfaction in knowing that it is costing Unitedhealthcare far more than $33.00 to deal with this issue. This, of course, raises the question, "Why should Unitedhealthcare go to this expense for a $33.00 claim? "

If you think the matter through, you will realize that each member of this Part D plan who purchases a brand-name drug through this plan is going to be subjected to this abuse. While each claim is likely to be less than $100.00, this plan is very popular due to the extensive advertising conducted by AARP and Unitedhealthcare.

Therefore, the total amount of money, should Unitedhealthcare be ordered to reimburse all its members, will run into the thousands. Even more important than my claim or the claims of hundreds of others, is that, as the Medicare Fraud and Abuse Contractor stated, the CMS regulations do not control this practice. A careful analysis of the billing structure of several Part D plans using information on the medicare.gov website's Planfinder reveals that the various Part D plans vary greatly in the way the deductible is handled. I have written to CMS to bring this to their attention and suggesting that they regulate how the deductible is handled. As I expected, I have not even received the courtesy of a response from CMS.

I subscribed to a Medicare D supplemental insurance through AARP, which was really United Health Care. At first, an amount of money was removed directly from my Social Security account monthly to pay for the insurance. As time went, the cost of the premium kept increasing until my monthly Social Security payment could not cover the amount of the bill. Social Security paid part and I was given an additional bill of over $100 a month. I soon realized that the cost of this insurance was excessively high and I no longer wanted to continue in this very expensive program. I called (telephone) and wrote letters asking to be removed from this insurance program, but I could get no response from United Health Care. I stopped paying their bills, thinking this would cause my insurance to lapse, just as it does in all of my other insurance policies.

All I wanted to do was to remove myself from this very expensive insurance program and United Health would not and did not let me leave.

United Health Care has turned the matter over to a collection agency (Receivable Management Services) for collection. My AARP Medicare Rx Preferred Plan has been cancelled, (after trying to get them to cancel it for months, hooray!)

It doesn't make any difference if you do not like or do not want their expensive insurance policy, they will continue to bill you and dun you. I doubt that they would have paid or covered any claim since I had not paid for coverage still they consider this a past due bill. I do not think that it is a common practice in the insurance industry for unpaid premiums to remain in force. Surely there must be others who wished to withdraw from an ever increasingly expensive supplemental insurance program.

I am a neuropsychologist and I was asked to see a UHC member for psychological testing. I filled out all of the appropriate forms required by United Healthcare and received a telephone call authorizing me to test their member. They gave me a cap on the hours (13 hours total) and an authorization number. I provided the services as promised and then sent the appropriate claim to the United Healthcare offices.

When they sent me the check, there was a note on the Explanation of Benefits saying I had agreed to a discounted fee (an approximately 50% discount, mind you) through an organization called MultiPlan. If you haven't heard of them, you're in for a treat. They contract with insurance companies to try to persuade clinicians to agree to a reduced fee and they get paid a percentage of what they "save" the insurance company. Needless to say, I do not and never will have an agreement with this company as I do not support fraudulent business practices such as this.

When I contacted United Healthcare to straighten this out, they told me that I had to deal with MultiPlan. MultiPlan never answers their phone (I wonder why), so I got nowhere until I filed a complaint with the Better Business Bureau. This got the attention of Cindy Hernandez, a Consumer Affairs Advocate for UHC (1-800). She researched this issue and came up with a fabulous solution! She decided that United Healthcare had authorized this treatment in error and paid me in error after I had rendered the authorized treatment to their member. They then "recalculated" the claim form and decided that I actually owe them money! They have asked for the entire amount back ($966.68). They have a very fancy way of explaining their "logic" and have added that the original error was with their processor and they have arranged for her "to receive additional training or other intervention as appropriate."

With a second patient, they attempted to get me to accept a reduced fee through MultiPlan for another member and I declined. After that, they refused to pay me at all for the services I provided to the other member. As I'm sure you know, United Healthcare is the focus of a class action lawsuit in New York because of their fraudulent business practices. This is no surprise to anyone who has the displeasure of doing business with them. They approved me to test this individual and the fee was $1,750. They only paid $966.68 and are now requesting that I return the full amount to them one month later.

Last week in April my physician faxed over a pre-determination request for IVIG infustion shots. 5/4/10: I phoned in to speak with Steven Dean and he said I was pre-approved for treatment and they would send out notification to the physician's office. 5/10/10 I spoke with my physician's office and they hadn't received anything so I called and talked to Tony at United Healthcare. He stated I wasn't approved yet and also that he didn't even have the pre-determiniation paperwork. The physician's office re-faxed the information over.

5/19/10 I spoke to Lisa to ensure the paperwork was received and it was in the proper hands. She confirmed and said I should know within a couple of weeks. 5/24/10 my physician's office phones me to tell me United Healthcare faxed them all the documents back and said they had never heard of me and I wasn't covered under United Healthcare. *Please keep in mind I'm waiting on treatment*

5/24/10 I called United Healthcare again and spoke to Chris (he is great) and he called over to care coordination for me to discuss my case. I talked to Victoria who was less than concerned a note had been sent to my physician and was not helpful at all. I asked to speak to a supervisor and she was also not willing to let the supervisor know it was an important issue and I needed a phone call returned that day. I left a message for Tim explaining the situation and my concern and to please call me back as soon as he was available. Tim NEVER called me back.

I called back six times on 5/25/10 to talk to a supervisor I spoke to Claudia, Angie, Adrienne, Eulander, left a message for Pamela, and Tim AFTER I specifically said I didn't want to leave a message for Tim as he doesn't return calls. In my converstaion with Eulander I asked for the name and number of the supervisor of the department. She said she couldn't provide me with that information as "in this day and age I don't know who you are and it's for our safety" I told her it should be public information and she said I could go find it publically but she would not help me. Tim FINALLY phoned me back and was less than helpful and didn't care about the customer service and the way I had been talked to. I was FUMING at this point. I asked for his supervisor and left a message for Adrienne Martin. She has yet to retun my call.

I need to go through an appeals process for my treatment...as this is MY main concern. I need to make sure United Healthcare can handle their jobs, not lose my paperwork, give me the correct direction...and TELL ME THE PROCESS. I have never been given the "run around" more with one organization in my life. The way I've been treated and talked to is so unacceptable and all I want to do is talk to a supervisor and have yet to do so in the Care Coordination.

At this point in time, I am beyond stressed and tired of feeling as though I don't matter. I have missed time from work and cost me time and money in making several calls that could have been taken care of in one. I've been sick for months now and I just want relief, I can't get relief until United Healthcare understands I need the requested treatment from my physician. How can I advocate for myself when they don't call back? I will continue to be sick and get worse until they approve my treatment.

I made many phone calls over the course of six weeks to UHC and their Cobra Insurance division attempting to correct their mistake of inadvertently terminating my health insurance coverage for no reason. On 4/22/10, I supplied to the Cobra division via fax their written confirmation of coverage. I had oral surgery scheduled for 4/30/10, of which I informed them and requested that they provide confirmation of coverage to my oral surgeon's office. On no less than three occasions, I was told that I was covered by my health/dental insurance plan and the oral surgeon's office would be receiving that confirmation by a certain date and time.

On each occasion, that proved false. On 4/29/10, after my total exasperation in trying to resolve the situation and have UHC and their cobra division successfully input the correct data regarding my coverage, I was told I would be informed by phone at 5 a.m. on 4/30/10 that my coverage was confirmed by UHC. The phone call came, saying it had not yet happened. They finally did it at 7:30 a.m. on the morning of my surgery.

My wife gave birth four months ago and since then, the claims by UHC have been postponed waiting to get "other" insurance information. My wife was employed and she was covered under her employer's health plan. She was also covered under my plan which I was paying premiums for the whole family. I was under the impression that I have my family covered with the best insurance options money can buy with little or no out of pocket expense if required by visits.

Today, I received that my claim has been denied because they don't allow "Duplicate" benefits. So if one insurance pays 80%, that's the limit all insurances would pay--which is a load of **! Why would anyone pay two premiums to get what he can with a single insurance? It doesn't make any sense whatsoever. I was given the option to appeal but as the representative mentioned, these are the plan's rules and there's little to nothing that can be done. I have to appeal in writing if I want anyone to look at it.

These thieves have been happy taking my hard earned cash, negotiating whimsical fees with the doctors while keeping the hefty charges on our tab and still want to go after our monthly premiums. I wish we had an alternative. Or somewhere we can complain and be heard. This is not fair.

When we signed up for this plan, it was the best my employer could offer. I bit the bullet and paid the premium to keep my family covered. But this is insane, this is robbery in broad daylight and we, the people who pay premiums are unable to do anything about it. We're at the mercy of these greedy companies that care for nothing other than their bottom line at the end. When I signed up for this plan, no one said anything about duplicate benefits. Not even the lady explaining the different options. How did this suddenly become the case? I have no idea.

I submitted a claim to United Health Care for $5,188 to be paid in network. United Health Care is saying they will only reimburse me the $100 co pay. I explained that the co pay is my responsibility and they are to reimburse me the $5,188. The representative is more concerned with whether if I paid the doctor already instead of UHC reimbursing the claim as they are suppose to under my plan.

I would like to bring to your attention a great injustice within the health care industry, which is a personal story which relates to many. Recently, all United Health Care members were sent a letter telling them that we must now get our medication through a mail order pharmacy if the medication is over $250.00. I received this letter yesterday which was dated March 24, 2010. I was about to call Walgreen's for my monthly order of medication when I received the letter. Moments after I called the pharmacy, they informed me that they were no longer allowed to fill prescription. I had only two days left which would not be enough time.

I called United Health Care and requested an exception since the time frame was untimely. They refused with great rudeness and tone. Yesterday was a big day for me as I was about to leave to go on a vacation by car. They offered to send prescription to me via UPS to wherever I was going. I did not know where in this trip I would be at the point of shipment as they could not confirm an arrival. I did not want my medicine going to a hotel in the hands of a stranger with fears of confidential detail intact. I could not take a risk of missing medicine with potential dangers. When I contacted the Walgreen's that would fill the order, they required permission from UHC whom would not grant the courtesy. I had to cancel my vacation plans with loss both financially and the personal strains.

My feelings are that this is a case of the following: Untimely disclosure of required changes caused losses and serious implications for assistance; Not the Health Care product I had agreed to when I enrolled. There was no mention of required mail order program; UHC employees customer service, hostile and rudeness with inflexible attitude and unwillingness to allow a month of grace to get transitioned; Long wait times on hold as the new service provider 'Specialty Pharmacy' did not cooperate; Threatened to send my medication to a hotel as a solution to the problem; Told me that I could get my medication at a Walgreen's and take a risk that I would not be reimbursed; New pharmacy 'Specialty Pharmacy' did not have my information and required that I have my doctor send a fax if I wanted my medication soon; Put me at risk of not getting my medication and caused me to have to cancel my trip when explained. There are many thousands of UHC patients suffering at UHC because of this change.

On Tuesday and again on Thursday, I received a call from AARP and United Health collection division saying that I owed over $800.00 in back payments from 2006 to 2010. I have just had my Medicare reinstated through Social Security Disability as of January 1, 2010. I was informed by Social Security Disability in writing that they were enrolled in part D through AARP and United Health. Both these phone calls lasted approximately 45 minutes. When I informed the operator that I had not been enrolled in Social Security Disability or Medicare since 2005 through 2010 because I had returned to work full time and I was ineligible to receive any these benefits. I informed the operator that I was receiving health care through my employer.

The operator said that they had a signed application from me dated April 2006 for part D. I asked her if she could send me a copy of this application or a form to request a copy of this application I was to have signed so I could see if someone has stolen my identity. She said she could not find a copy of this application to send me but would try to find a copy. I had informed the operator that I have disliked the AARP organization for years and until Social Security informed me in December 2009 I have shred all AARP correspondence without opening until then. I have never been a member of AARP.

I informed the operator that without seeing the application that I was to have signed by me in April 2006 showing that I was to have enrolled in part D, I was not going to pay the back payments. I did tell the operator I would pay from January 2010 when Social Security Disability informed me of my enrollment. I have received notification in writing every time Social Security has changed any part of my benefits. I have never received a letter about enrollment in Medicare part D until December 2009. Either someone has stolen my I.D. or AARP and United Health are trying to pull a fast one.

Employees at United Health Care admitted on 2 separate occasions that they processed a claim for physical therapy incorrectly. The physician's office has contacted them countless times to ask that it be corrected and that they pay the amounts due. It has been over 120 days and United Health Care has promised that they would pay within in 5 days on 2 separate occasions but they have never paid what they say they owe. The physician's office continues to send us notices. Help, what do I do? United Health Care is holding the money! They are accumulating months of interest on it while I am being charged for it. This is wrong! How can we make them pay?

United Health readily admits denying a claim citing pre-existing condition as the reason. The fact is there was "no" pre-existing condition. They stated that we needed to send in the previously existing health care letter stating that we were insured with them. This has nothing to do with them making that assessment without further research and documentation.

This will damage the ability to get proper evaluation in the certain event that I switch insurance carriers. Their indifferent and uncaring attitude that the repercussion from this action will cause is proof that "we", the public, are at the mercy of incompetent peoplein control of issues that can have grave effect on the health of their clients not just in the immediate but in the future as well. This needs to have some sort of penalty to the carriers who employ this type of practice. I was hit with a $18,000 bill from my provider.

Because United Health Care has denied the claim(s), once again under the assumption that the issue was pre-existing when in fact the issue was "not", the nightmare now begins. I will probably be forced to file BK as a result of their incompetence and their appetite to be profitable at any expense. I am not getting the medical care that I should be getting from my coverage. The $700 a month I spend in premiums I could have passed along to the MD and would not have this bill, not to mention the embarrassment when I was escorted to the billing office instead of the patient's room and scolded because my insurance had denied the bill. My ego will get over it but the pain I suffered for the next two days was inexcusable.

I have been forced to use Prescriptions Solutions for my very expensive inject-able medication that requires refrigeration. I have not been forced to use it for any other drugs I take. I filed an appeal with United Health in September 2009, so I could continue to pick this up at my local pharmacy and was denied by April B at United Health, via a letter in November 2009 that did not even address any of the concerns I had about having to get this medication shipped to my home.

That is only one example of no one listening to what is being told to them. That has been the standard for every person I have dealt with at United Health and Prescription Solutions. One issue is they are not able to package this consistently to guarantee it is maintaining a stable temp. That compromises the efficacy of the medication. We have been able to confirm the temp. of the shipments when they arrive and some are dangerously close to the 76 degree limit this medication can with stand others, we are positive have exceeded it. I have complained every time I get a shipment, and the ones that are not usable have not been replaced by Prescriptions Solutions.

I was told by Don E., a supervisor at Prescriptions Solutions they would never replace any order that was not usable because the medicine is too expensive. I was told by April B. and her group when I was arguing the denial of my appeal, any time the medicine arrived and could not be used because the temp. was to high, or some animal had urinated on the box, or it got rained on all day while the package was waiting on my door step, it would be replaced. I can not bring my self to inject anything into my body that has been exposed to these kinds of conditions.

Now, I am dealing with a blatant contradiction of what I was told, and Prescription Solutions obviously has the upper hand because I did not get my medication replaced. Dave the pharmacist at Prescription Solutions is truly one of the most ignorant people I have encountered in years. He has me 100% convinced he is not a pharmacist. The things that he said about this medication, and the lack of knowledge he displayed about this medicine convinced me he has no pharmaceutical training at all. My husband spoke with him also, and was left with the exact same opinion.

At one point, my husband called back to speak to Dave the pharmacist, and my husband was asked by the girl that answered the phone if he could describe Dave because she was not aware of any one by that name in the Pharmacy. How in God's name can a person describe some one they spoke to over the phone? After my husband explained he spoke to him only minutes earlier, Dave amazingly was found, so my husband could speak to him again.

Dave also gave me contradicting information about the packaging of this medication by Prescriptions Solutions, and also did not know that it shipped from the same place he was working. These are just a few examples of the lack of competency I have been forced to deal with. I could go on more about this, but hopefully what I have stated is enough to paint the picture.

All I want is to be able to pick this medicine up at my local pharmacy that is 1 mile from my home, and not have to be billed the out of network price for this medication, and have some level of comfort knowing it has been handled properly. I feel I am being denied my coverage for this medication because they can not get it to me in a fashion if feel comfortable using it, and they are discriminating against me because of the drug I have to take for my condition.

I have had 2 relapses of my condition since getting this medication from Prescription Solutions. I am convinced I am getting sub standard medication because they can not get it to me in usable condition and that is why I have relapsed. I need this medication to maintain my quality of life, and I have not been able to to that since being forced to get this medication from Prescriptions Solutions. I have had huge hospital bills, and an unbelievable amount of stress added to my life since having to deal with these people.

Because of the additional stress, I now have to take additional medication to try to stave off the effects this stress has on my condition. The damage is on going, and I predict my condition is only going to get worse. I am paying the premiums for this health coverage, so I can get the medication I need, and now I don't feel I am getting what I am paying for.

I am insured by IBM as a retiree with UHC and went on disability in July 2006. I received Medicare type A and denied type B as I had hopes of returning to work full time. My doctors and medical providers have submitted claims to UNC with no problems until September 2009 when UNC began rejecting all claims, stating that Medicare had to file the correct paperwork before my claim could process. I contacted UNC at least 6 times in 2009 to have these claims resubmitted, in which they were although any new claim was rejected, necessitating a call.

As of January 2010, they rejected all claims, even though I have called them 7 times, stating that I must provide proof that I do not have Medicare type B and why I only have type A. I have thousands of dollars in claims outstanding. My providers are sending me notifications of bill past due and demanding payment. I do not have the funds to pay these myself. And this constant refusal to honor my claims is causing me medical distress with my high blood pressure and constant fear that the providers may start legal proceedings to collect their fees. I am afraid to schedule additional appointments due to non-payment. This is compounded by the fact that I am an insulin dependent diabetic, with a kidney transplant and high blood pressure.

I transferred my insurance to COBRA through UHC. My dental insurance is with Aetna so I need UHC to get my account information updated to Aetna. I made my payment but didn't get my dental coverage because Aetna said they didn't receive any information from UHC. UHC said they received the payment, updated my account and sent my information over to Aetna.

I called UHC a number of times just to be told to wait for three to five days. Nothing changed. When I called again after three to five days, a different rep spoke with me and made another request for me. I was told to wait another three to five days. I talked to their supervisors a couple of times, which didn't seem to help. More strange, I once spoke with a guy they called Mike who suggested me to pay the dental bill first and promised that the issue would be solved later the day.

I was told he was a supervisor there. Next, he was gone on vacation for a week. After the week, I asked to speak with Mike, but the rep said that there wasn't a Mike and he didn't know any supervisor named Mike there. My experience with UHC was just like that. Every time a different rep picks up your call and tells me to wait X days--just like nothing happened before.

Another time, I was with another supervisor. I was told that they would escalate my case and follow me back within three to five days. Of course, I haven't heard anything from them. I gave them the time and today is the sixth day. So I called again and they said that my account was updated on March 1st and it took three to five days to complete so I have to wait until this Friday. Just the same **! Hasn't my account been updated many times already?

I am a Type 1 diabetic. I was a customer of United Health Care under a previous employer up to January 2008, and they are aware I am a diabetic with access to my health records and doctor visits to maintain health control of my diabetes.

I was laid off and looked for work for 9 months and found a new position. I enrolled for healthcare in September 2008. I was eligible to enroll 2 months later, according to work policy for enrollment. The policy claimed a 3-month exclusion for pre-existing conditions. In other words, they won't cover any insurance coverage of a lifelong pre-existing condition that requires maintenance care. So what good is a health insurance that won't help you cover you chronic condition?

Regardless, I waited the 3 months, and at the end of the 4th month (March 2009), I had bloodwork done to test my diabetes control. This is standard preventative upkeep and maintenance of my condition. They refused coverage. Nothing was said, and the hospital and United Health Care bickered back and forth for 11 months.

I received a call from the hospital telling me they are being refused payment for the lab work by United Health Care. UHC's response was I have to provide paperwork of my pre-existing condition, which they were well aware of, given the fact they were my carrier in my previous position, and they know I am a type 1 diabetic.

A bit beside the point. The main issue is my policy claimed a 3-month exemption for coverage of a lifelong chronic condition. I waited 4 months, and they then throw up a red flag failing to pay a year later and after wasting many hours of contact I have spent with customer reps trying to resolve this. I asked to be notified after they initially looked at this complaint 2 weeks ago. The first response I got was from the hospital informing me it is my responsibility to pay for the service, despite the fact I had health insurance, which refuses to pay.

I lose health care for that period and regain it on return. But, I still have diabetes, and the insurance company then refused coverage for a pre-existing condition because I was forced to have to leave my job for 3 months, so that my very same employer can hire me back.

So at the very best, I can get coverage for only 3/4 of my working year I am allowed at my company. Even then, United Health Care will refuse payment as they did for my maintenance bloodwork. How is a diabetic supposed to maintain good management of his disease, when healthcare companies go out of their way to refuse payment and coverage, even when their client is paying for coverage?

I am furious. My health insurance carrier is trying to either bankrupt me or kill me. I have to pay out of pocket the full cost of maintenance procedures, because they refused coverage of a lifelong illness for 1/4 of the possible time I have health insurance. I barely can cover the $40 co-pay to see a doctor, let alone hundreds of dollars for lab work that should be covered under an active health insurance plan that they refuse to honor citing pre-existing condition despite being past the 3 month window.

Result is I cannot afford to get my next lab work, because I do not know if they will cover it, even though I now have active coverage. If I get hit by a bus, I am fine. But I can't manage my illness because of their lame rules. So I pay for insurance that doesn't help me, and they keep the profits.

This is a follow up to 2/17/2010 complaint concerning AARP UHC Medicare RX claiming a "glitch" in their books to over 42,000 senior citizens. Today 2/26/2010, United Healthcare sent 2 letters stating premiums were all paid through "1/31/2009" but you still owe $1,010.80 in back premiums (keep in mind today is 2/26/2010). 2 weeks earlier, letters said they were only paid until "1/31/08". So what is it? Am I to assume that for the month of January 2010, my AARP Medicare United Healthcare RX premium is $1,010.80?

Looks like UHC is cooking their books for the SEC, investors, IRS and anyone they can cover their mess up with. How can things be paid, not paid and then paid. Added of course is with much harsher language, if you don't pay back money owed, we will cancel you and put you in collection. What is this really all about? Seems like we all went down this road before with corporate/Wall Street babble and blues, yak blunders and lies. If nothing else, check the UHC books. We are being made scapegoats.

United Healthcare sent me a letter stating the drug that I have taken for 6 months (Advandamet) will no longer be covered, unless my physician states to them in a letter or phone call within the next 30 days, that this drug is needed for me. Basically, the insurance company wants me to go to a cheaper drug (Metformin). To give you some history, I have taken Metformin for the previous 3 years to control my blood sugar, to no avail. Advandamet has Metformin and another drug in it. As explained by my doctor, I need to keep taking it. He even stated, why have a doctor, if the insurance is going to tell you what they want you to take?

My theory is Medicare suggested and even stated that this company has the most stars of all the companies listed, so naturally, I went with them. Shouldn't the company be liable to let us know that changes were going to be made, before the period of changing your benefits, that begins each October. My period to change companies is over, according to Social Security Law. I feel this is an intentional act, and that 30 days to schedule an appointment to a doctor, and even have to have the audacity to ask me ,to ask my doctor, to play secretary, lawyer, and judge to my insurance company, is absurd. If companies are going to go under the table to do business, they should be held accountable, until we can go to the table and change along with Medicare. This has caused mental anguish.

I am a Pharmacia/Pfizer retiree who has had insurance through United Healthcare since my retirement in 2004. I have never had a late payment and that can be verified by SHPS, PO Box xxxx, Louisville, KY 40285. In 2009, my monthly premiums were $589 which were always paid on time. During the enrollment period for 2010, I found out that since I had turned 65 in the year 2009 that Medicare would now be my primary and that my monthly premiums for myself and husband would be $568.84 per month (I have the printed document stating this).

At the end of Dec. '09 and Jan '10, I submitted my payments in the amount of $568.84 and both payments cleared. When I received my billing from SHPS for the time frame of 2/1/10 - 2/28/10, I noticed that the total current charges were $568.84 (as usual). However, there was a charge of $820 with a notation (previous balance) and the balance due was now $1,388.84.

On 1/28/10, I called and spoke with April A. and she informed me that since I turned 65 in 2009, my premiums should have increased at that time and they did not realize it until I renewed my insurance for 2010 and therefore the $800 was the difference between what I had been paying of $589 and what it should have been. I questioned why the rate was changed without me being notified, plus the fact that it has always been my understanding that the insurance could not be changed mid-year unless it was a birth/death event, and while turning 65 was traumatic it did not qualify as a death event.

After much discussion and she didn't really have an explanation of why I had not been notified, she indicated I could file an appeal, which I did. The appeal # is xxxxx. She indicated I would be notified via email (and verified my email address). Today, 2/18/10, I received my statement from SHPS for 3/1/10 - 3/31/10 and again the amount shows current charges $568.84, previous balance $820. Since I had not heard from anyone, I again called and this time spoke with Johnny P. He informed me my appeal had been denied but could not explain why I had not been notified. I was on hold for an extended period of time while he attempted to get someone to assist in getting the email sent to me, but was not successful and indicated he would continue trying and return my call. I asked if it would be possible for me to pay the $820 in installment payments by paying $100 or $200 extra a month. He indicated he would check with SHPS and get them on the line when he called me back.

He did call back and then had Matt on the line from SHPS. Matt said that the monthly payments of $568.84 that I had submitted for Jan. and Feb. had been applied to the $820 balance and therefore I was behind on my regular payments and my insurance was about to be canceled. I questioned how that could be when the statement I'm looking at for 3/1/10-3/31/10 shows current charges of $568.84 and previous balance still of $820. His explanation, "I guess we could do a better job of our billing, but looks like that is the way the payments were applied." I am astounded that first of all they can charge me $820 for a mistake that they made, and second of all that all of the billing statements that I receive do not reflect what is actually occurring. I appreciate your time and consideration.

Our daughter is in an inpatient (intensive care facility). We were told by Ms. S. from UH yesterday that our doctor had recommended our daughter's immediate release and that further coverage for the facility would be denied. Stunningly, this turned out to be "false" as our doctor recommended exactly the opposite. We are engaging my wife's HR department to expose and correct this outrageous and potentially dangerous and unjustified denial of coverage. We are also waging a personal war against the company over its notorious practices. I hope the Democrats and Republicans in Congress can someday have the balls to correct this domestic nightmare. Until then, we're on our own out here fighting for ours and our loved ones' lives.

United Healthcare has recently changed its policy regarding triptans (such as Imitrex, Relpax, Maxalt, and Amerge) used to treat migraines. In December 2009, I picked up my usual prescription, 12 tablets. This treats 6-8 migraines. Since many of my migraine triggers are not controllable (such as weather changes), it's not unusual to have that many migraines per month, even with preventative treatment. In January 2010, I refilled my prescription. When I got the prescription home, I found four pills.

On calling the pharmacy, and then UHC, I found that they now only pay for four pills per month. That treats two to three migraines, tops. On calling UHC, I was told to send in a request for an override, and that it would take 30 days. My medication is around $20-$25 per pill. That's up to $50 per migraine. What am I supposed to do until that override is approved, or if it isn't at all?

They are awfully close to practicing medicine without a license, when they tell us they know based on some statistical model how much medication you need. They are overriding your doctor's treatment without ever examining you or talking to you. What's more, it's cruel to not allow people to have the medication they need. It's wrong to wriggle out of the obligation to pay for the care that your subscribers are paying for. There is a special place in hell for the people at insurance companies who change medication coverage rules at whim, or deny care on technicalities.

I have made many unecessary trips to the drug store and have spent numerous hours on the phone with United Healthcare and they refuse to honor their written committments. I encourage you to investigate this practice and consider a class action lawsuit in behalf of the members being abused by this company. The amount I have to pay exceeds the copayment listed in their plan and their website. Millions of other consumers are having to do the same.

In May 2008 I was seen by my doctor to have test done to make sure I was healthy. Everything came back good. No problems. In October 2008 I found out that I was sick. United Health Care is now trying to "determine" if this was a pre-exsiting condition. Which in May proves that I was not. I have been with United Health Care since Jan 2008. Now my medical bills are not being paid. They keep giving me the excuse of that my current doctor has not sent in the needed paper work. I talked to someone with UHC a month ago and come to find out that they were sending the info to the wrong address. Well there still is noting being done a month later. My bills are now over a year old and they will be turned over to collections in ten days if I don't come up with the money. This is clearly not a pre-exsiting condition.

Home Care received authorization #1733701389 to provide nursing service to a United Health Care patient. Two Registered Nurses provided the service. Service was provided 16 hours per day, 7 days per week between 9/21/09 and 10/09/09. Total cost of the service is $13,984.00. The claims were sent in for payment and several calls were made to United Health Care Inc. To date, the claim has not been paid. When I call, I get a run a round and no one seem to know whats going on, please help, thanks

I have my daughter covered under United Health Care Insurance. Her father holds the primary insurance and this is secondary. I have NEVER heard of a secondary insurance not having to pay for anything! They say they are a non-duplication insurance, not responsible for paying once a primary insurance has paid. I never would have bothered paying for this insurance had I known! Not that I believe this is legitimate... Now I owe over $400 for testing (MRI/MRA) to Avista Hospital despite the fact that I only have a $100 copay and have met our deductibles.

United Health Care has had not one but two federal level class action suits against it in only two years for grossly underpaying providers. Both suits ordered the company to substantially revamp their claims paying process. This has not happened.

It is now November 2009 and over half of my husband's 2009 medical bills remain unpaid. They have used every phony trick in the book to avoid not paying-falsely claiming a gap in coverage, falsely claiming a third carrier is involved, enforcing payment deadlines the providers cannot possibly meet because United Health Care is actually the secondary insurer and the providers must wait to receive payment from Medicare, the primary insurer, before billing United. They also put the wrong RX Bin number on our member card so the pharmacy was receiving a do not recognize this number warning using the number on the card. As a result, the pharmacy could not bill Medco, United's prescription drug plan. They are also falsely claiming the providers have not included Medicare's EOB when billing UnitedHealth care when the provider is adamant that this information was given to United.

Their application form failed to ask if my husband had Part D of Medicare, the prescription drug plan. As a result, Medco, United's prescription drug plan, was incorrectly billed as primary when they were in fact secondary. A portion of Medicare's payment, the primary insurer, is supposed to be applied to our United Health Care deductible but was not. They said they would call me back to resolve these matters but when I tried to call the number left on my cell phone, I got a message that the number had been disconnected. I could go on and on but that gives you a taste of the problems.

When I was in the hospitl for 15 days in okla city I had health insurance to pay $1000.00 a day and it took over 6 months of them sending me documation of all my doctors over and over and take there sweet time to answer me back or hard to reach a rep to have them call you back. They have very bad customer service having these excues. Finally had to get a attornery to finally help me pay out the claim they owe me . Never ever use united health again threw aarp.

Also, can doctors refuse to buy the device? Can they tell you to buy it yourself? I mean, this is a medical device not a loaf of bread.

My husband works for a company that has less than 100 employees. He has Health Coverage and is paying over 400.00 per month, with a 3000 deductable. My prescriptions are 10.00 if there is a generic, if not, we are forced to pay 50.00, which is a very high amount. Recently, I went to the ER for back pain and was diagnosed with phenomnia and copd, my Primary prescribed 2 medications that I had to have to get better, when I went to fill them, it was 110.00. As many, we do not have that kind of money. I called My doctor and she called in Generics, but indicated that she didnt believ they would work.

My condition worsened, the Doctor then admitted me to The hospital to make sure I recieved the proper medications. I spent 4 days away from my family to get better. The insurance will now have a 10 or $15000 hospital bill, which I always have problems getting my claims paid. I have spent hours on the phone trying to get my previous claims paid. I am very frustrated and cannot understand why they would choose this route. Over half of the employees ay my Husbands workplace were forced to cancel their insurance, we feel like they are trying to get us to cancel ours, which my husband and I have decided we simply cannot afford it.Every year the premiums go up, ALOT.

My illness was prolonged and worsened, I was away from my family for 4 days in the hospital, all because of 50.00 copays for non generic medically necessary medications that we could NOT afford due to the over 400.00 a month cost for insurance.

I currently subscribe to Medicare parts A & B. I chose United Health Care as my supplementary medical plan. However, I have been very dissatisfied with their unwillingness to acknowledge any of the medical costs incurred by me during years 2008 and 2009. I have come to realze the brochure provided subscribers offers inaccurate information.

United Healthcare, my company's health insurance provider, is denying medication to my husband with Crohn's disease.

On 8/18/2009, Alan, my husband, was prescribed Cimzia, a drug used to treat active Crohn's. United Healthcare requires a pre-authorization in order to cover Cimzia. The first pre-auth was denied because the doctor's office, stated that Alan needed the drug for his Crohn's disease. UHC required that they state that it is ACTIVE Crohn's disease.

After correcting this oversight and resubmitting the pre-auth. we received a letter from UHC stating that the drug had been approved. The File ID # is 11636220. However, when we tried to have it filled the pharmacy said it was denied because although it was "approved for quantity, it was not approved for distribution."

When I called UHC I was routed through their maze of automatic phone systems until I was told the drug was approved and summarily disconnected. However, when I contacted the pharmacy they still could not fill the prescription.

It is now 9/15/2009 and I still cannot get an authorization from UHC. In the meantime, my husband is suffering from active crohn's, cannot eat without severe pain, and is rapidly losing weight.

I have called UHC and spoken to Dina, Rebecca, Karen, Madelaine, Mike, Rena, Mandy, Christy, Todd, Maria, and Manny. Manny now claims that UHC never received the additional authorization information they needed from my doctor's office. Manny would not transfer me to his supervisor.

It has been almost a month, I've spent countless hours on the phone and talked to 13 people to date, trying to get this taken care of. Our doctor's nurse has called countless times, and we still cannot get the medication that Alan so desperately needs.

Please help us get this straightened out.

So when e contacted UHC they are giving each another number and not picking the call. Not even telling why the cliam is not processed for more than 2.5 moths. Hospital telling that they have submitted all the required docs. Where we have to go and ask? whom we need to complaint.

United Health Care subsidiary company Prescription Solutions Pharmacy handles Specialty Medications for diseases. They mail medications that are mailed on "ice" within 24 hours. The only problem is you have to fit into their "mailing schedule". In other words, they will not mail your medicine for you to receive on Saturday. So if your medicine is on "ice" and you live in the southwest where the temperature averages 105 degrees or higher daily then your medicine may be "tainted" by the extreme heat.

Prescription Solutions doesn't care about your medicine, you, or the quality of your medicine. They are not accommodating and UHC Prescription Solution Pharmacy claims mailing over night is expensive. Since United Health Care is a Multi- Million Dollar company I find this excuse to be highly unlikely. Further, Prescription Solutions provides a reminder call that is too early and therefore you cannot refill your medications due to needing a "prior authorization". The stupidity to this is that they don't even know their own rules. If you order your medicine too soon the health care company denies it and requests a prior authorization. How can they not know a "no brainer"? It is up to you the patient to advocate for yourself. United Health Care Prescription Solutions Pharmacy will not accommodate you the "patient" it is all about them, their schedule and their cost at their convenience.

I have Been with Unieted Healthcare/Golden Rule for more than 25 years. Every year the rates increase wheather I used it or not $40.00-$50.00 / year. Thia year I received a letter explaining this years increase and it is being raised $1200.00 / year!! The letter also states that this increase is for all insured customers and is not a result of my personal use of the policy. I want to hear from other Golden Rule Clients to find out if this is true or not. My thinking is if we can band toghether and catch them in a lie we may be able to get a class action lawsuit against them. I would hope my email address is listed so others may contact me and we can discuss these unbelieveable rate increases. Please, anyone who has Golden Rule insurance e-mail me and we can try to keep these folks honest. Thank you!

United Healthcare has repeatedly denied payment to Dr. H. for a surgical procedure performed on November 17, 2008. Attached you will find a copy of the FDA approval for marketing the Novasure Endometrial Ablation System. Novasure is an FDA/Department of Health and Human Services approved method for treating menorrhagia in pre-menopausal women.

Beginning November 2006, I began to experience excessive menstrual bleeding. I had 3-5 day periods every two weeks. I regularly passed blood clots in excess of 30 mm, as large as a half dollar, experienced depressed sexual interest and mild hormone related depression. I was evaluated by Dr. H. in March 2007, a uterine ultrasound was performed, fibroid tumors and polyps were noted, and a D&C was performed in May 2007. Pre-surgical symptoms abated until approximately June 2008, when excessive and breakthrough bleeding began to reoccur. I began to bleed every 9-14 days, pass large blood clots and began to regularly experience a rush of bleeding where I would saturate tampons in minutes and experience dizziness and the urge to faint.

I was re-evaluated by Dr. H. 9/2008, a uterine ultrasound was performed, fibroid and polyp growths were noted. I was seen by Dr. H. on 10/9/2008, and options were discussed. Dr. H. expressed concern with the growths, as it had only been seventeen months since the previous D&C. A second DNC would be necessary to remove the invasive tissue, and the Novasure Endometrial Ablation System was discussed. Novasure destroys the endometrial lining/vascular tissue, preventing the growth/attachment of invasive fibroid/polyp tissue.

The D&C and Novasure Endometrial Ablation were performed 11/19/2008. Post surgical results are positive. Bleeding is almost non-existent, and I have experienced no complications or reoccurrence of pre-surgical symptoms.

Health insurance exists to cover medical necessities such as this procedure. I pay insurance premiums to cover this surgery. I pay my insurance premiums to United Healthcare with the understanding and expectation that medically necessary procedures will be paid to my physicians. UHC paid the hospital expense for this procedure. UHC paid the anesthesiologist for this procedure. UHC has repeatedly denied paying the gynecologist for this procedure, yet I pay my premiums to cover her fee EVERY SINGLE MONTH. Cost to me of $4,400.00 and threat of credit issues for non-payment.

I have been a UHC consumer for several years now. I have Lupus and have been hospitalized several times in the past years. They have paid for NUMEROUS blooddraws, sometimes equalling over $2000. Even after all this, I have never been required to meet my deductible before services were paid.

This past winter I decided I would like to have an IUD inserted. Having Lupus, I am not supposed to use any form of estrogen birth control. I also have a history of endometriosis and have always had abnormal bleeding issues. Both I and my physicians office contacted UHC prior to the insertion. We were BOTH told that the service was covered and not subject to my deductible. All I would be responsible for would be the office copay of $30.

So why am I surprised that a few weeks after the procedure I was sent a bill for $511? The amount of my deductible, plus $11 for whatever. I have argued with UHC for months. If there was even a chance it had been subject to my deductible I would not have had the service done. I cannot afford $500.

Finally a manager faxed the letter to me. It stated "A second appeal may be made within 60 days of the date of this letter." How ironic that I didn't receive it until almost 2 months after that date. That won't stop me from filing the 2nd appeal, but I am furious. These insurance companies are lying and cheating their way into billions while hard working honest Americans suffer. It's a complete crime.

I had a PPO Health Insurance Plan with United HealthCare. I had some blood tests done at my doctor's office and sent to CMLAB, INC. I have received a letter from the Lab saying that the insurance company had denied payment for the test provided by them stating that this Lab is not on the United HealthCare network. I am not a Health Insurance expert, but for my understanding when you have a PPO type of insurance the facility providing the services don't have to be on the insurance company network. They should be liable to receive payment for the services they provided to me by United HealthCare.

I would like to know who could you help me with this issue. I have paid a lot of premium to this company and feel outraged they are not paying for this bill. This Lab has done their job by providing me and my doctor with the results and I very much would like them to get paid, it's just fair. I would like to thank you very much in advance for any help or tips you can giveme to resolve this matter as soon as possible.

They [said] would pay for John of Grace Home Health to clean and rap my left left. And then they did not pay for it.

We had a child patient that presented with over 80 warts on his fingers and arm. The physician removed them and really only billed United Healthcare for 24 of them. We were denied payment on all but 3 because "we removed more than the policy allows in any one day". We tried to explain to NUMEROUS departments and people and we even filed a request for review. They still say we should have brought the child in and painfully injected him EVERY time and only remove 3 warts at a time. That would mean this poor child would have to come in 28 different DAYS and be injected repeatedly EVERY VISIT. Explaining that these warts interfered with his tactile sensation, etc. and telling them that it would be highly unethical to do that.....United didn't care. So sad when those who have power over our health loose morals and ethics. The total bill was only for $1700.

2009. When trying to get meds filled I keep getting told I have no coverage until June 1st. It is my understanding if you loose health coverage and have a nother privider like my husbands insurence there is not suppose to be any laps in coverage. Three weeks have gone by and I have no coverage.

Had to pay for meds out of my own pocket. Now will not be reimbursed because I had to have this mess taken care of in a week. I need to take cymblta every day. After missing two days of this med I get so dizzy that I can not function and have to lay down and not move my head or is cause me to feel like I am going to vomit.

Beginning in approx Oct/Nov 2008 every time I have a Dr.'s visit or have testing done, United Healthcare claims not to be my primary insurance thus denying my claims. They are and always have been my primary insurance carrier with my medicare as secondary. I pay approx 400.00 dollars per month for this coverage for the past 3 years. I am a disabled firefighter. The fire dept is supposed to pay my health insurance for life because I was injured in the line of duty but because while I was waiting for my social security disibility to take effect I was also diagnosed with another health condition in addition to my injury the fire dept is claiming that my disability is due to the addition of the secondary condition. Even though I recieved my full pention and social security paid me from the date I was disabled in the fire dept they still say it's not good enough. Anyway that's neither here nor there, my problem rests in the fact that United Healthcare regularly denies my claims now claiming they are not my primary resulting in hours of phone calls.

I have a flexible spending account. The IRS rules say I have to use this money by the end of the year. In January I contributed about $189. I lost my job on January 30th. No notice - just goodbye. United Health care will not let me submit any bills against my Flexible spending account beyond January 30th.

What a scam...and what a great revenue stream for the insurance companies given all the people loosing jobs. Mine isn't much money but the cumulative effect is enormous. If I had known I was going to loose my job on the 30th I would have gone out and bought aspirins etc. (I had to fly to DC to lose my job) This is an insane way to treat people and it is also stealing. There has to be some reasonable window of time to use what we have paid in. The irony here is that I still have United Health care benefits and they are still being paid my premium.

I have only lost $100 but can you imagine the amount of money insurance companies are keeping that people have lost their jobs could use? Criminal

My wife developed a tumor which was discovered in September of 2008. I looked in the 2008 Participating Provider Directory that the insurance company sent me which indicated that the University of Michigan Health Systems was a participating provider. As an added precaution on September 29, 2008, prior to any medical treatment, I contacted the insurance company via its toll-free number and spoke with Jennie and asked for participating providers near my location. She gave me the same information as contained in the provider guide.

It was not until yesterday, February 24, 2009, when I contacted the University of Michigan Health Systems about the bills I am receiving, that I found out that the information in the guide and given to me verbally by the representative were in error. I have been appealing the insurance companys refusal to pay, but I am now getting my appeals back and they have also been denied.

We are going to get stuck with over seven thousand dollars ($7,000) in medical costs not covered by the insurance company.

I have had trouble with UHC before, but 2008 beat everything. UHC denied claims because they said my husband and I have other insurance. We do not and have not had for some years. UHC is secondary to our medicare. I had to call over and over and over again to try to get claims reprocessed. Here I am in February still working on claims from last August, September, October and November. I'm not surprised about the delay on December, but last year I was trying to get January paid for as late as August. This is shameful.

My doctors are not being paid, and in some cases, we've been threatened with collection. I have had to call all and explain what has been happening with UHC. I don't want to go to an attorney yet, but I want my complaint to be heard.

The insurance company just know how o take our money, no customer service very rude, attention everyone please call you provider for everything you need has their approval on how much is the amount of dollars need to pay before visiting doctor office. This is ridicilous

After countless written and telephone discussions regarding a surgery that I had on April 22, 2008, my healthcare company, Optimum Choice A UnitedHealthcare Company, refused to pay in full for a procedure to correct excessive menstrual bleeding a procedure that both my primary ob-gyn and the ob-gyn who did the surgery believe should be covered at 100% under my policy. In 2007, I experienced a miscarriage and since that miscarriage I had been suffering from excessive menstrual bleeding. Initially, I was told by my primary physician to expect a lot of bleeding, so I waited for it to get better. In November 2007, it had not improved at which time I went to see my primary care physician, Dr. B. complaining of excessive bleeding. He conducted a papsmear and did not find anything out of the ordinary.

In 2008, the bleeding got worse. I had periods that lasted two weeks long and included several days where a super tampon and a super pad could not contain the bleeding for more than 30-45 minutes. I contacted Dr. B. by telephone in 2007. He suggested at that time that I go to an emergency room, but by the time I got his callback the bleeding had abated some and so instead I came into his office the next day to have it checked out, at which time he referred me to Dr. R.. Dr. R. saw me in December 2008 and determined that I needed a hysteroscopy to address the excessive bleeding and recommended that if I wanted to have children to also get a laproscopy. After many discussions with Optimum Choice I was told that the laproscopy would be covered at 50 percent under the infertility benefit and that the hysteroscopy, which I was finally told did not require pre-approval, would be covered at 100 percent when linked with the diagnosis related to excessive menstrual bleeding.

With letters from Optimum Choice and an assurance by D. R., the Optimum Choice manager handling my case, we finally scheduled the surgery. On April 22, 2008 I had surgery for excess menstrual bleeding which included a hysteroscopy to remove polyps and a laproscopy to clear the area in case I wanted to have children in the future. In June 2008, I was told by D. R. that R. submitted only one bill for both procedures, and because of this both procedures were inaccurately linked in the bill to the infertility diagnosis for the laproscopy. She said this was simply a billing error and could be rectified by R.'s office submitting these bills separately with their respective medical diagnoses attached. R. tells me they submitted the separate bill multiple times, but these were not received by Optimum Choice.

By this time, almost 6 months after the surgery, D. R. left the department and I never heard back from anyone. In October-November 2008, I called and spoke with Stacy several times and finally with A. J. who said my only recourse at this point was to submit a formal appeal. In December 2008, I contacted both Drs. R. and B. to collect medical records related to the appeal and on January 22, 2008, I called and spoke with Mary to let them know the appeal would be arriving shortly at which time I was informed that the last date that I could appeal was 180 days after the surgery, which had passed on October 22, 2008. I believe Optimum Choice is responsible for paying for the hysteroscopy at 100 percent.

I have wasted hours and hours talking with Optimum Choice. My physicians wasted hours talking to them prior to the surgery. Their accounting offices wasted hours submitting and re-submitting bills as requested. I wasted $60 paying for medical records for the appeal, which they just informed me can no longer occur. And now I have medical bills totalling an additional $586.23 for a procedure that Optimum Choice assured me was covered under my plan.

I took my child to the dentist on 07-16-07 because he had a lose tooth, when I talked to receptinist I asked her if they take my insurance and if will be in network, she made a phone call and verify if it was on network and we went in, while he was there they did a cleaning and some fillings

I paid my fees and we got onother appt. for the rest of the treatment we went in there twice after the first appt. and everytime I paid fees that I was resp. for.

Three months later I got a bill from the dental place stating that the ins. did not pay for the rest and that i need it to pay. I went to dental place and we call the ins. and it was some kind of miss understanding that it was out of network, we told them it was in nework and I think we even fax some paperwork and made some phone calls and they said it was fix.

Two months later another bill came in with the same amount, I went to the dental place and they did not receive payment they only paid a portion, I call ins. several times and they said theres a check floading for the amount, I requested a sup. and and I talked to Gilbert Lopez and he said he will take of it that it was dental place error but he will fix it.

Weeks later I got a call from ins. stating the same version there were I check floading I gave them dental office # and he said he will fix it. I got another bill couple days ago with late fees.

I called to get a quote and I was given a quote for a comprehensive plan. What alarmed me was that because I have not been insured for more than 60 days I would not be covered for the first two weeks of an illness. I was appalled by this policy and she said this was a standard practice. Like I was being unreasonable.Then I thought I must be misunderstanding this and I asked her does this mean your company will not cover the cost incurred in the first two weeks but your company will cover the costs incurred after two week holding time. She said yes.

This is crazy. When My stepdad found out he had a brain tumor, the hospital bills for the first two weeks would have bankrupted our family. A long history of paying on time and being responsible would have been gone in two weeks. What is the alternative, not having the care? If you are having to pay high premiums why should they have this policy, I know why.

Two managers at my employer, a California division of United Health Group, Inc, concealed from me their actions of identity theft and distribution, plus medical identity fraud by giving fellow employees my personal identification information along with false information about my health status thought the guise of distributing a fraudulent workman's comp case document that they created without my knowledge, consent or signature and then authorized?.

Months passed before I had complete knowledge of their actions, at which time a witness fortunately disclosed her observations and direct knowledge of what transpired months earlier. Those details can be provided as needed in a subsequent contact.

Originally, when I called 911 when my husband died, United Healthcare tried to bill me for the ambulance that tried to save his life. I was then given the wrong information by one of the reps that told me by law, I could be on cobra for three years. My husband's boss again informed me he only had to give me cobra for 1 1/2 years but would honor the misinformation and insure me for the three years. (Of course, I did pay for it but it was discounted.) Every time I needed to have something paid the rules changed.

In August of 2007, I had a breast cancer scare. I was told I had to pay for a deductible of $3000; the remaining balance was about $1800. I paid the hospital this amount. It took months and so many phone calls to finally find this out. Each time I called, I was told they did not have record of my calling the month before, so I had to start all over.

In November of 2007, I needed eye surgery on my right eye. Because I paid the deductible, again after months of calls and stalling medical people they finally paid. I had the same procedure on my left eye in December of 2007, which is still not paid. They paid for some but not all. I've been promised it would be taken care of on several occasions, to no avail. I finally spoke to Kelly on 6/2708 at approximately 10 AM. Kelly is a rapid processing associate, that called each medical vendor to tell him/her United Healthcare would pay. Kelly told me it was just a glitch in the computer system and they had been having problems. She said once I had the confirmation number, the company must pay. I explained to her that the stress of this was too much. I was in good credit rating and wanted to stay that way. She again assured me this would be my last phone call.

Since then, I have received those bills again and in fact, one company has put me with a debt collector that is threatening me to ruin my credit. Why would this company pay for one eye and not the other for the complete and exact amounts? I didn't have another deductible, since both surgeries took place before the end of the year.

The consequences of this incident is my stress level. I don't know what to do. Can anyone help, please?

I supposed to start my treatment in the end of June, 2008. Dr. faxed prior authorization form to United Healthcare and waited when the insurance company responds. United Healthcare sent me a letter stating that they cannot approve treatment because they cant contact my doctor. I went with this letter to my doctor and she showed me 7 faxes sent in different dates trying to get prior authorization. On 07.30.08 I paid for my doctors time to get her FAX THIS FORM AGAIN with the sign Urgent! on it. I made sure that the fax went through. The representative from United Healthcare stated that the process will take about 48 hours.

On Friday (48 hours later) I called them again and one representative stated that it will take up to 30 days. I AM SICK I NEED TREATMENT FOUR WEEKS AGO! When I insisted, the representative put me with the conflict resolution person, who after having me on hold for a while stated that I need to talk to pharmacy, he gave me a pharmacy number to get release of medications. Ive never heard of pharmacy giving anybody release of medications, but I called my doctors office and asked them to call pharmacy. They called me 10 min. later saying that the pharmacy needs PRIOR AUTORIZATION FORM FROM THE INSURANCE COMPANY.

I know that Im caught in a vicious cycle of insurance company not wanting to authorize my treatment, and Im asking you to help me to expedite this process. The next week I will probably contact a lawyer to learn about my options, but what should I do now? Thanks. My health is deterioratng and I face disability IF I DON'T GET MY TREATMENT!

My husband is teaching at a university in Utah for the summer, and so we are living out of state for two months. Six days ago I fell and fractured my distal shaft (right 5th metatarsal). I was informed by a PacifiCare representative that I should go to an urgent care center. I was also told in the same phone call that if I needed to see a specialist thereafter, I should have my PCP in California approve the visit. I went to the urgent care center, had my foot x-rayed, and was told I should urgently see an orthopedic surgeon, for I may need orthopedic surgery. I was given the name of a good orthopedic surgeon, and checked online last night, happy to see that he was an approved doctor in PacifiCare's lists.

However, today after I contacted my PCP for a referral, I was informed by the Palo Alto Medical Foundation that they could not offer a referral. So I contacted PacifiCare again. Now the story changed: I could not be seen by a specialist and would have to return to Palo Alto in order to have anything covered! Only urgent care and emergencies would be covered. Is not seeing an orthopedic surgeon, to ensure that I will not have permanent damage, urgent and even emergency?

This is insane. I am now on crutches, struggling to get around to care for my 11 month old son and to ease the burden on my husband, who is teaching part-time, telecommuting full-time, and now doing most of the childcare and household duties for us. I am due to travel to Oregon in nine days to attend my grandmother's 100th birthday and to attend a family reunion celebrating my brother's return from a 2 year mission in the Dominican Republic. I have already been very concerned about traveling with my son just in a short flight to Oregon. Now I am being told by PacifiCare that I can only be treated if I fly back to California. I have many questions which I ask that you answer: Is PacifiCare ready to pay for this plane ticket? How will I drive myself once there, seeing as my right foot is in a gigantic boot? How will I travel with my son to a place where I do not have parents ready to pick me up? I can't leave my son with my husband, for his teaching schedule and telecommuting already makes for 60 hour weeks and time out of the house when he cannot watch David. Will I get treated if I pop into an emergency room in Utah and demand orthopedic surgery there? If so, then I understand better why our emergency rooms are overloaded with care that should be done elsewhere by those insured.

I was told today by the PacifiCare representative with whom I spoke that these are the confines of an HMO. Ridiculous. I cannot believe an insurance company would offer such deceptively incomplete insurance. I cannot believe my school district would sign up for such a plan, either! I have not yet contacted an attorney but am on the brink of doing so. I have lost the ability to communicate with people who don't listen. I feel deceived and cheated. This shoddy coverage is wrongful and should be considered illegitimate. Please respond in detail to my questions. I need a way to be seen by an orthopedic surgeon here in Utah, immediately.

My son had outpatient eye surgey in January 2007. The claim was processed in March 2007. We owed 20% of the contracted price and paid that amount without incident. In June 2008, the claim was audited by United Healthcare & they found they had made an error in the original allowed amount of the surgery. The increased the allowed amount and sent additional payment to the hospital which in turn left us with an additional balance (because our 20% increased).

We had the claim reviewed & even appealed the decision based on the grounds that 18 months after the surgery was an excessive amount of time to reprocess the claim and that the original error was not our responsibility to correct. We ultimately had to pay the additional amount in order to keep the bill from going to collections. The letter of response to our appeal basically said that the claim was processed according to our policy and there was nothing else to be done. Ethically, this is just ridiculous. After 18 months, if you made an error, I fail to see how I am at fault as a consumer.

In my discussions with their customer service and claims representatives, I was informed that there was no time limit for reprocessing claims or reevaluating claims. In effect that makes the policy null and void because there is no security that a claim is truly processed and closed. For example, a person could have open heart surgery in 2005, the claim could be processed and the patient's responsibility paid. Then, in theory according to UHC's stated policy, in 2035, they could "discover" that the original claim was incorrectly processed and sudenly this person could be responsible for an additional amount of coinsurance (in an expensive surgery that could be hundredsa or thousands of dollars).

In my situation, it was just very frustrating to know that they were only paying lip-service to my issue. They had no intention of understanding my issue. I KNOW I owe 20% of the charge. I paid 20% of the charge and I don't think 18 months later it is ethical to reevaluate the charge thereby making me responsible for an additional amount for a claim that I had already paid in good faith. Times are tight economically for everyone right now. I had to pay the additional amount on my credit card and will now be paying on it for years instead of being finished with this claim from JANUARY 2007. Emotionally, I just feel abused and powerless. I had no choice but to pay and no additional options within their organization to appeal to.

I have Cervical Dystonia, Dr. at USF Giving me Botox Injection from Last 2 years, when needed. On 5/27/08 Dr. Gave me Pricption for Botox Injection, I took it to Local CVS Pharmacy. United Healthcare Refuse to Pay. When I called they say I have to Send Appeal in writting. I didn't have any proof of refusal. I have neck pain. I took injection every three month to controll the pain. Now What about my pain. Who will suffer