UnitedHealthCare Reviews

UHC canceled my surgery (4 days before) and said I had to find another doctor from the "Provider Network". I downloaded the list from UHC web site and thought, "Oh not so bad, there are 51 doctors listed. it will not be too bad just much more terrifying without having someone I know and trust," but that was not the case. One group with each doctor listed over and over (some listed as many as 6 times). They run commercials about every 15 minutes on local TV stations fishing for unsuspecting patients (if a physician must resort to television advertising that is huge red flag). I called and was told no I would not be given an appointment with a doctor. I would be seen by a nurse and she would decide when and if I needed to be seen by a doctor and it would be a month before I could even see the nurse!

I already had a biopsy done and provided it and I could not see a doctor! The next doctor available was 54 minutes each way from my home! That is NOT a reasonable distance. I filed an appeal and of course the response was "You do not have out of network coverage (well I already knew that). Duh that was the issue, I could no longer see the doctor I had established a relationship with during a very difficult diagnosis and treatment plan!

I have called UHC numerous times with absolutely no assistance other than see our web site! Or, if you are not comfortable waiting for more than a month to see someone you can always pay out of pocket for services... Well why would I have insurance? Where am I supposed to get this money from, my copay went from $25 to $45 (though UHC repeatedly processes my Primary as a specialist) and charging me $45 copay (one was more than a year ago and they still have not paid my doctor properly).

Then there was the "fasting blood work". I was sent to 4 different labs by UHC each one when I arrived at the address the Lab was closed and had been for months, I would call UHC and be sent to another closed location. The fourth location "bingo" there was actually a functioning lab, I signed in and sat to wait my turn, I see a sign on the wall, "Please have your insurance cards and credit card ready for the receptionist." Lab Corp required that I leave them a copy of my credit card for them to automatically take any amount due! NOT! NO WAY do I leave my credit card in someone's database or file folder to be used at their pleasure. I ended up going to the local hospital though not in Network. It was now 12:30, I am fasting and still no blood work has been done. Again I contacted and filed a grievance to no avail as it was simply an error with no "malice".

Just 2 days ago they once again called which I blew a fuse and told them off. I am sorry that I chose UHC and will assure you that our membership in AARP will be reviewed by me as well as coverage with UHC when enrollment time comes in 2014. How's it that an association like AARP gets involved with the MORONS of UHC??? I have used most of my minutes speaking with these folks and I am not even sure that all is resolved with them. Please get involved and settle this issue. Thank you.

We signed up for insurance in December 2013 ... for Jan 2014. We were approved and received our cards. Then our banks sent us new Visa cards with new numbers due to the Target security breach. When UHC West tried to withdraw the money... it was declined... That was the beginning of UHC West's inability to handle a situation. I was told since we were originally approved for enrollment, we only needed to submit a reinstatement form. Weeks later I was informed that was inaccurate and we needed to re-enroll. It has been two months since the beginning of this process. After I re-enrolled I was told to call back next week. I have submitted our bank routing number and account number so it can be directly withdrawn from our account. This is unacceptable. Where do the reserve members go to change this? We are without insurance that we qualify for and we can't call customer service that can help. We are told to call back next week because United Health Care has no direct customer service for military reserve members.

Fortunately, my medication arrived the day I ran out. With the **, they refused to approve the dose my Rheumatologist prescribed for me, which was 120 mg. once a day. They said the "medication book" indicated that only 60 mg was needed for depression. My doctor and I went back and forth repeatedly with them explaining that the ** was for Fibromyalgia, not Depression. Yes, ** was originally prescribed for Depression, but was then changed for use for Fibromyalgia. I finally got the necessary prescribed amount, but my doctor had to send forms four times and there were also phone calls.

Anyone who has tried to call United Health knows that it is a nightmare to speak with their representatives, if you get that far. You can't get the same answer twice from any representative. I told my doctor she should have sent them a bill for her time, since she had billable hours and I didn't. I have a letter allowing one of my medications (maybe both) with an end date in April. I will be starting the approval process in February, so as to allow me time to get "permission" before I run out. Another issue I have had with United Health was that I was "forced" to use Mail Order Prescription Service for three of my expensive medications. I never used this opportunity with my previous insurer, because my mother had problems with missing or stolen medication. I preferred to pay one month extra out of my pocket, rather than trust Mail Order.

If I didn't use United Health's Mail Order, I would have been required to pay the full cost every month at my local trusted Pharmacy. I had to order three prescriptions over a three-month period and Express Scripts (their Mail Order provider at the time) managed to screw up every one of them. Try talking to two companies that were clueless about dealing with other. Bet Mental Health had a serious increase in cases until they got rid of Express Scripts. OptumRX, their own company service , continued the mess by making me go through approval for medications, because absolutely nothing was transferred correctly. My final opinion, so far, is that United Health, could screw up a two car funeral. I would willingly pay more to go back to Blue Cross Blue Shield. I had them for several decades and never went through such stupidity and garbage. Let's hope that my service with United Health doesn't get worse now that I have voiced my opinion of them.

SO, whenever my son needs to see a specialist (which, unfortunately is quite often, due to some medical conditions he suffers from), I have to actually FLY him from Dallas to Denver to meet with his PCP, who can then refer him to a specialist in Dallas. And so, of course, I have to fly him back home to see the specialist. The round trip airfare for this is in the range of $500.

This is ABSURD, but UHC refuses to be flexible on this. They won't even let my son "meet" with his PCP over the phone to get a referral - they INSIST that he sees him in person. This is what I mean by them making things so difficult that people simply give up. I know they want me to say, "To heck with it, I'll just pay the entire bill from the specialist, to prevent paying for the round trip airfare". This is SO VERY WRONG - it should be against the law. UHC SUX!!!!!

What I thought is the provider was double billing. They weren't. It was United Healthcare doing the double billing. Why would an insurer do that to themselves? The only answer I come up with is to find the cheapest amount they have to pay. Also, they have wordy policies that are contradictory regarding the same diagnosis. I really wish we had a better option, but in general healthcare is becoming more and more of a nightmare. I'm still in the beginning of investigating why an insurance company would double bill themselves. I will keep you updated on what I find.

UHC gives only two "Emergency fills" at your local pharmacy. Last year alone, I had to have 6. Half the year worth of screw ups, by UHC's pharmacy of choice. I am left with the cost of two prescriptions. Right now I am waiting for a Saturday delivery. It never showed up. Again all I got was I am sorry. That doesn't cut it. I work. I don't expect people who work to pay my way, but I will never be repaid for time lost from work to run to the pharmacy and wait. That is if the local pharmacy has any of the medicines on hand. UHC has been nothing but a headache since I started with them.

I called UHC and they told me the doctor was out of network. I said, "I have your BRAND new booklet here in my hand that says he is in network." I was put on hold for about 15 minutes. They came back and said my doctor has 2 numbers and the number he used for my claim was the out of network number??? I talked to the doctor's office and was told ALL claims are submitted with his current number and he retired several years ago from an office in a different city and UHC must still have that number on file and are using it for his claims. Now I am 3 months behind with unpaid bills and still can't get UHC to admit their screw up. Evidently it isn't a screw up, just a SCAM to get out of paying out what is owed.

When I got the bills for my part of the medical costs, instead of being a few hundred dollars as I expected, they were about $4,000, representing 20% of the cost of the operating room, hospital, surgeon, anesthesiologist, etc. I learned that because I headed home late that night, the insurance company was treating my entire surgery as an "outpatient procedure", charging me 20% of all bills. Because I chose to minimize my stay and the cost of my medical care, they are characterizing this surgery as an outpatient procedure. Crazy. I appealed of course, asking them to treat the surgery as inpatient, since I had been admitted and my doc was planning on my staying at least one night. They denied the appeal in a circular argument that was based on the logic that they made the decision they made because they made that decision. Bottom line, people, stay away from United Healthcare. They are scoundrels and they don't give a care about people, circumstances, reality, or YOU.

The doctor in charge has tried to reason with United HealthCare but obviously all their employees have medical degrees and they deemed it an unnecessary procedure. I believe United HealthCare is making medical treatment decisions based on $$ and they will continue to do this to others. If you have a choice in insurance plans PLEASE do not give your hard earned money to United HealthCare Insurance. They don't care about anything but their bottom line (like most).

Now finally, after living in hell all that time, I had a new sleep study done. The sleep study report revealed that I stop breathing a minimum of 10 seconds at intervals of an average of 80 times a minute in REM sleep. Think about this for a moment! So the United Healthcare Sharp doctor who requested the sleep study then NOT URGENT?!!! I should have just purchased the cPAP Machine from Canada a long time ago. This program is terrible! Goes on vacation for a week without leaving any notes on my condition thereby lengthening the suffering time waiting for "her signature" on the prescription to generate my badly needed machine.

After yet one more week of waiting for her to return, I was told she had signed off on the script and now I must wait for the insurance approval. I called in today to see how long this would take and was told that the "review" takes from 3 to 5 days and they would let me know. When I asked why this "review" was even necessary or if they could speed it up, I was told that my United Healthcare/Sharp primary doctor "did not mark it as urgent!" So when my blood pressure spikes roughly 38,400 times in each 8 hour sleep period, this is "NOT URGENT?!! This program is terrible!

I was a day later at a doctor's office and a receptionist there told me what should I expect since I was on "welfare". Apparently, the medical card which I was issued says "community plan" which tells participating vendors that this person is a welfare patient. I have contact UHC V-P, Gail Boudreaux concerning this practice only to find that it is given to the "Consumer Affairs office". After not hearing anything for a few weeks, I called today to find out that some man had posted in UHC records that he contacted me and that I was uncooperative. What a blatant lie! My present financial conditions affords me the ability to find another company with a medicare plan, which I am going forward to explore and change from this "yuppies" who think they can treat people however they want.

United Healthcare does not regard its customers as people but rather a source of income. Their current behavior of terminating many health care providers and services from their plans has been a major blow to the patients and their families. In many cases, they have not even provided the common courtesy to inform the customer of their actions but have left it to the caregivers to inform the customer that their care providers are no longer acceptable to United Healthcare. They have ripped trusted caregivers out from under the customers, many of which have been long time and great caregivers.

United Healthcare states that its action is because of the CMS (sequester) reductions and the Affordable Care Act. They say that it is to improve customer health care services. This is hard to believe when they have cut the number of caregivers significantly and are trying to impose ever increasing numbers of patients on fewer caregivers while reducing the compensation to the caregivers. It is also interesting that the Wall Street Journal indicated that United Healthcare made approximately 1.5 Billion Dollars in one month of operation. These poor corporations do not have the money to provide for the customers' healthcare needs but the billions of dollars that they make is not enough for their greedy pockets. Obviously, the customer is an object to be used and abused for the greater profit of the shareholders and corporation. I wonder if they treat their own families the way the treat their customers.

To be blunt, I cannot recommend United Healthcare for health insurance. They may be the largest healthcare insurer in the nation but they also have become the 800 pound gorilla whose only concern is for greater profits no matter the means or methods of obtaining that goal.

Supervisor: "We're just a third party to read you your plan policy, we can't help more because we don't work for Oxford, we are only under contract. We need your physician to talk to the PA department to confirm this medication is necessary." Isn't that the reason a physician writes an Rx in the first place? I ended up paying my insurance premium, and for my Rx ($167) out of pocket. Instead of my insurance paying for my Rx, my insurance premium is a cost on top of my medical expenses and adds no value, just a waste of my time.

68 year old man with a fractured leg bone is denied a diagnostic test so that the degree of injury can be determined and treated. During nine days, bedridden and in pain, the "review board" was given numerous documents by the treating physician and used one word or phrase in the doctor's notes to find the loophole to deny the test. The most recent communication with a representative was to go to the emergency room and get some pain medication (that's a $100 co-pay plus the cost of the medicine) and the painful experience of getting transported to the emergency room.

United Healthcare's review physicians have long forgotten to "first do no harm". This is outrageous...if this was one of their loved ones, you can bet they would not be allowed to be in pain hoping for treatment! I hope they all choke on their profit margin!!

I used their website to find 2 PCMs within a 100 miles and sent off the application. I called every week to verify if everything was complete. Every representative reassured me everything was good. I never received any paperwork from UMHC saying that my application was accepted or denied. I even called a week before October 1st and was reassured everything was in order. Unfortunately I had a medical issue the first week and had to get medical care. I looked online on UHMC and I had been knocked down to Standard.

So I called UHMC to find out what is wrong. They keep on telling me that I do not live close enough for a Prime PCM. All of you vets know that Oahu has the largest Navy, Army, Air Force and Marine Corp bases. This representative had no idea and I always got a different answer from each representative. Also the doctor's list on their website is incorrect. Most of those doctors' info is out of date or incorrect. They don't even use that list to find your PCM. The zip code for the doctor I requested is 96753 which is not in a PSA reduction zone. They had it listed as 96086, which is Siskiyou County, California. So no wonder they keep denying my application.

I have talked to numerous managers who have used the standard tool for distance (Go figure, Google Maps) and measure the PCMs at 96.3 Miles and 95.1 miles. I also had a representative tell me I had to be 100 miles from a Military Treatment Facility. Kaneohe Marine Corp Air Station Medical Clinic is 98 miles from my house. I had to call each PCM, verify they accept Tricare Prime, Accepting Patients and was able to take kids (6 Yr old). So with all this information, Acceptable PCMs (which I had to verify with the Representative because the website is of no use), distance (which was measured by at least 3 managers and in which those managers emailed saying the zip codes were incorrect and on top of that there are acceptable PCMs at 85 miles), then sent to enrollment.

What do I get. Letter saying I live in a PSA reduction area. No **. Don't try to get to anyone in enrollment. That is not possible because they don't exist in this realm of reality. I am so flustered I am going to write my congressman and then I am getting a lawyer. If any of you are having the same difficulties let me know. If any of you have any suggestions it would be much appreciated.

United Healthcare denied payment. I read through my policy and found that she was eligible and had to appeal. After the first appeal, UH only approved three days of treatment even though the treatment program was 28 days. This was only approved after I spent hours on the phone with one of the representatives and contacted my employer. Unfortunately due to HIPPA, my company (who was covering 75% of the costs) couldn't get involved in an effective way. They kept having to defer me to the representative. For the next 21 days my daughter's treatment was reviewed every three days to determine whether or not she would still be eligible for treatment. Their reasoning? They didn't pay for programs, they only paid for what they deemed as necessary care.

My daughter was using methamphetamine, ecstasy, marijuana, alcohol, ** (no prescription), mushrooms and cigarettes and she was only 15 years old. She was running away from home to live on the streets, she was cutting her arms and her legs, she had dropped out of school, her friends were all addicts, she was attending raves, she had been arrested three times and on and on and on and even with two assessments United Healthcare denied treatment after 21 days. I went through the appeals process until I ran out of appeals. To get my daughter the care she needed, I paid nearly $4000 out of pocket to get her in treatment and when they denied payment for treatment I drained my savings account to continue care.

I couldn't believe that I was spending $5100 a year for health care and then even more on top of that to actually get the services we needed and when it was time to UH to pay up? They refused. One of the biggest problems we encountered is that UH uses the APA guidelines to determine care and their own internal guidelines to determine care. WA state where we live uses ASAM criteria for substance abuse which is different than the APA. The bigger issue is that the guidelines that UH uses are also internal guidelines which they won't share with you. UH is a company who strives to keep their stockholders happy not their customers. UH wants to take your money but that's really the end of the deal. They take your money and you pay for your medical costs.

I've learned since that UH denies payment as a regular practice. I'm appalled at the thought that we pay for medical insurance and it's hard to actually get coverage. Over the three years I was with UH, I paid them A LOT of money and I rarely met my deductible. When we actually needed our medical insurance, they did everything they could to deny my child treatment. Over the years, I paid them nearly $10k and for the first two years, they didn't pay a DIME to my doctors because the deductibles were so high it was all out of pocket. The final year I paid $8600 in healthcare costs and they paid about $6k. How in the world does that work? I would rather pay a penalty tax to our government than ever give UH another cent.

Their representatives are there to look out for the company's bottom line, not your medical needs. You pay in more than they will ever pay. It's not a good or even poor value for the money, the coverage is non-existent.

I called UHCMil and spoke with another employee and relayed the information I that I learned from DEERS. The employee told me that indeed DEERS does not have anything to do with the UHCMil computer process. To make the story short, I was told by another employee from claims that their claims and authorization departments now have matching record that I do not have no other insurance.

After that, I was also told to have my doctor to resubmit the request again. This is the third time. I told the employee that UHCMil should just take care of their erroneous denials and correct it internally. I still do not have the authorization to have my lung disease biopsy. My hospital procedure schedule was cancelled two times already. Is there any class action lawsuit against UHC for endangering patients' lives?

Most recently, I have a referral that I called regarding and they promised me that they saw the note about dental insurance and NOT other health insurance and they would resubmit the referral for processing. They asked me to check the website for updates to the referral and it should have been updated in 24-48 hours. Seven days later, it still wasn't updated...so, I called again. I asked for a supervisor. Denied, he was busy. Asked for the referral management team, they don't take incoming calls. I explained my previous issues and how I HAD spoken to the referral management team before after being transferred there. Sorry. I asked to have a manager call me back. She said she could do that.

Four weeks later and still no call. I am starting to believe that they deny referrals and make people frustrated JUST to the point they say it isn't worth it. The point is however, my husband earns these benefits for our family... Regardless, of whether they want to approve it or not, they are choosing not to. It sounds like I am not the only frustrated member of the military's new Tricare provider, United Healthcare. I want TriWest back... Who is with me?!?!?! Good customer service all around and accuracy in their computer systems. Is that so much to ask?

Result: I am stuck with $26,000 in hospital bills. Impossible to get answers from telephone calls to UHC. The reps on telephone have no idea what they are talking about, can't refer you to a supervisor and don't have telephone number for appeals department. Tried to call INC from hospital and they don't take calls on weekends. UHH acts in bad faith. I will have to refer to Virginia Insurance Commission as last option. DO NOT ever select UHC as your insurance company.

THEN, I was without insurance for a month, not my fault, and also had a lady actually laugh at me. I finally got it fixed under the condition of resending another automatic pay and paying three months ahead. Well, this is October. My payment STILL won't go automatically... Every time I call, they say we are paid until November, which isn't true. They are HORRIBLE, HORRIBLE, HORRIBLE! I am about to switch over to my husband's insurance, which is a shame since it is a good price.

If a relatively minor covered item entails all of this, what might it be like for a major operation? I wasn't waiting around to find out. Enter my new healthcare provider, HealthNet. Exact same item sought but not obtained through United Healthcare (though it was specifically covered in its contract) was delivered by HealthNet without any hassle in less than two weeks of policy commencement!

Had I known of this significant increase in 2014, I would have looked more closely at other policies. I can't imagine every company is going to have a 53% increase in their premium. I am also distributed that when I spoke to two company representatives they did not inform me of the increase, although it is only 3 months away. A word to the wise -- before you sign up for Part D prescription coverage, call or email the company and ask how much they plan to increase the premium the following year.

I agree with others that if the Affordable Healthcare Act is supposed to work for the people, there should be some oversight on this. There are actually insurance companies that do not even need referrals if the 'specialist' is in their network. This is just one more scheme to make their numbers look good for cheap costs on claim processing to the businesses. It is possible their costs to process a claim are lower than the competition, it is because they will find some minute little wording to not have to pay a claim. I am still trying to figure out why there are co-pays for general services. Paying premiums of hundreds of dollars (and for some thousands of dollars) a month for a service, what are we actually getting for these high premiums? Kicked in the teeth by obscure policy and code. I am sure Obama being a government employee is not using this low budget insurance company.

You can pretty much forget about their appeal a claim process because they will find some little word to turn it against you and blame it on you as the poor little person that did not read twenty plus pages of obscure language in the policy. It has actually become that the insurance companies run how the hospitals and doctors practice medicine. It is not about getting affordable quality care and taking care of the patient. It is more like, can the doctor see four to eight patients an hour and get them through the door. Pass them off to the primary care doctor and give someone pills just to make them happy. And do not run any tests since that will cost money. Isn't the purpose of testing to help prevent a more expensive outcome later?

United Healthcare is NOT in business to heal people, they are in business to make money. Doctors are in business to heal people. I believe a doctor has gone to school way more years than a business person and would know when specialized care is needed. It is not a prudent use of resources to waste time and money keeping track of referral paperwork. I would be interested in the number of people that are denied claims because of lack of referral paperwork. Referrals just seem like a lot of wasted money having old fax machines, keeping up logging of these items, having someone check if it is within this time frame, has the person exceeded the number of approved visits, and on and on. If the doctor that has contracted with UHC is the primary or a specialist in their network, there should not be a referral system.

What has UHC done by listing these primary and specialist 'in network' done? If they are in the list, haven't they agreed to certain contracted limits on costs already. It is not necessary to have referrals and have extra overhead costs in maintaining such frivolous information. What is actually on the referral? One doctor stating my patient needs more extensive help than I can provide and I am referring them to the care of a physician who had more schooling in one particular body part more than I did basically. I cannot see how a referral system saves the insurance company money except that they do not have to pay claims fully.

There should be a ZERO ranking as one is way too high. Power to the people to stand up and fight for corruption in healthcare.

The other issue I had was with counseling. I had called in before I started seeing a counselor and was told it would be no problem even though it was someone specializing in panic disorder and OCD. This provider did not deal with insurance directly, but gave me a detailed receipt to mail to insurance for reimbursement. When I had been going to the counselor weekly for 2 months, I got a denial letter. I appealed and appealed but they claimed it was out of network and they wouldn't cover it at all. I was again out more than $1000 and was not able to complete counseling.

These people are crooks! I never had this trouble with Tricare West. Their mo is to deny, deny, deny until you get so frustrated and confused you give up. Ridiculous. No matter so many mental health issues in the military go un-noted.

United Healthcare took over, supposedly in May 2013, and since then the military care has been in a shambles. We no longer are approved as a provider and patients that were under my care can no longer receive treatment from me, nor can I refer them to other providers as I am not an approved treater. My staff have been trying since 6 months before the switch to get credentialed by United Healthcare, and all we get is that it will happen next week. Well next week has turned into almost a year and nothing has happened. This should be considered a criminal offense by the government and United Healthcare should be banned from providing care to our military. Why is Obama not stepping in to correct this criminal behavior?

In addition, I, ironically, carry United Healthcare in my office for myself and my staff's medical insurance. Our experience with them has been abominable as well. I have a claim into them for $12,000 dollars of medical care that they have not paid and refuse to review, even though it is within the statutes of my policy and the laws that govern them. I have filed an appeal which they refuse to acknowledge saying it was filed too late, when in fact it was not. I believe this is a serious situation and the outcome will prove to be another corrupt business, close to if not worse than the scandals of the financial institutions of this country that are yet to be fully punished. What a SCAM!

The call center called me back at 6 am my time leaving a message without any contact information whatsoever telling me my request for single case agreement was denied. She proceeded in the message to tell me the reason it was denied was that she could find me an in-network appointment over an hour away from my house with another provider. In calling back the call center to explain how far away that was and asking to re-negotiate their stand, they sent me from person to person with the exact same story about the fact that my provider could not be considered because there was an appointment available an hour away.

So, I called the medical facility and I was informed that they had coded it correctly. I then asked them to call UHC to clarify the issue. They called UHC and UHC admitted it as a billing error and accepted the charge. The reason why I am writing in is that this has not happened with UHC for the first time. Last year also, they refused to pay a bill for another routine physical procedure and the hospital sent me the bill. UHC will try to get out of these payments to the extent possible and have patients pay the premium and also the procedure charges. Also, their customer reps are extremely ill-informed and need to improve their knowledge and stop lying.

After two weeks I hadn't heard anything so I called UHC. They said, "Oh... we are missing a page of the application". So I had to resend the application and then was told it would be "5-10 business days". Two weeks later they finally told me that the application looks good but they need the back premiums. I had the back premiums because they never took it from me to start with. So I gave the woman my numbers and expected to be reinstated. Keep in mind my wife is pregnant and needed to get in to see her OB doc. She called her doctor and was told we still didn't have coverage. I called UHC AGAIN and was AGAIN told it would take another "5-10 business days" to process the payment. I called UHC every other day and was told to check back "on Friday". They also kept telling me that they were putting comments in the notes to "expedite" my requests.

So meanwhile it has been two+ weeks since I paid the back premiums. My wife is still pregnant and hasn't been able to see her doctor... she hasn't been able to fill her prescriptions... and now my 4 year old son is sick and I'm going to have to pay out of pocket for his care. I called UHC yesterday and was told by someone else that it takes "Thirty or more days to process a reinstatement". Why didn't they tell me that in the beginning??? And seriously, what takes so long??? I told UHC several times that if they could not or would not insure me then to please let me know and I'll shop around for other insurance (which I'm about to do) but they keep telling me they want our business. The people have always been friendly on the phone but if the military contracted with the lowest bidder they definitely got what they paid for. And I still don't have health insurance.

Then I submitted them electronically last month hoping to resolve the problem and yesterday I receive the same form again. The entire process is so asinine. I pay hundreds of dollars a month to insure my family on top of what my employer is paying and they can't even pay a bill for $200. They would rather play games and send me the same stupid form over and over so they can deny my claim. I hate to imagine what would happen if I ever got really sick. What is the point of paying for this type of insurance if it won't be there when you need it...

To top it all off, unfortunately, my mother in law passed away and we have gone through a lot of ** to get a refund for the COBRA that we should have never had to pay to begin with. United makes a lot of excuses as to why we haven't been refunded...It's petty, unbelievable and sad. They took our money so quickly and while we are mourning her death, we have to fight for something that is rightfully ours. There are no words...

I have been receiving bill after bill from the ER physician for the amount of $6,000.00. Health care plan paid NOTHING to this doctor and this physician, who I later learned was out of network, claimed I now owe him his fee of $6,000.00. I have appealed this with the health care plan and am continuously denied!!! I need some help in getting this physician to leave me alone and stop with his ridiculous bills, as well as the threat of being put into a collection agency! This has become a total nightmare for me and I am at the end of my rope. I CANNOT PAY THIS LUDICROUS FEE and think it is totally absurd for a physician who is on staff, was the on duty ER physician to even do this to me. What can I do???

I have made it very clear with UHC that I'm willing to setup an EFT as long as I have control of my funds going out. What TRICARE/UHC is asking me to do is unconstitutional as it violates my 4th amendment rights to privacy and control of my assets. It also violates The Electronic Funds Transfer Act $ 913 so what they are doing is illegal! I have also been burned in the past and had my identity stolen, and I'm being very careful of who controls my finances. The TRICARE/United Healthcare issue is a separate issue that I must fight.

United Healthcare has been almost impossible on the phone. When I do finally get them on the phone, I have spent hours on hold and relayed to another operator trying to get to the bottom of this issue. Their claim processing seems to be better but their billing department practices are illegal and I feel justified to question them. I currently have this case with the GI Rights hotline, The ALCU, Congress,

If I was on Medicaid, I could walk in the door of the imaging dept. and answer no questions at all and get premium care. All of my deductibles and out of pocket costs allow ever useless POS NON-PRODUCTIVE PIECE OF HUMAN GARBAGE to have everything, and I get declined or have terrible wait times to get anything done while paying bills the garbage in this world.

Growth Hormone is a crucial hormone for her to continue to have a healthy life. Growth hormones affect much more than just a child's height. The entire body is affected by a growth hormone deficiency. Serious health issues can arise relating to: heart strength, lung capacity, bone density, liver, kidney and immune system function and much more can all be impacted by growth hormone deficiency. Growth hormone is an essential component for every child.

Growth hormone treatment for girls with Turner Syndrome is a standard of care and, based on this information, we have asked that United Healthcare reconsider the $10,000 maximum plan benefit limit for Growth hormone. We feel this is an insufficient benefit amount to properly care for our daughter's health care treatments. The fact that United Healthcare has set an annual limit on a coverage benefits knowing that there is a possibility that the limit on this benefit could lead to further health issues is just unacceptable.

We have tried to get answers and help from the drug company but they advised we are not eligible for assistance in the access to care program because we don't meet the annual income of below $100,000. But even with an annual income of $110, 000, we can't afford to purchase this medication at a cost $52,000+ a year. Yes, 20 mg is $1,750.00 - that's 2mg shots 6 days a week. This is an extreme amount for our family or any other family to handle. This cost would be more than half our annual income. United Healthcare hasn't denied our daughter coverage for her pre-existing condition but they are restricting and denying her treatment for her pre-existing condition. We just want the best care for our daughter. We are trying to give her what we and her doctors feel is the proper treatment for her condition.

Then I receive a notice that the additional information was received, the claim approved and that it has "already been paid," except they never actually pay the claim. I hate to say this, but I honestly believe they are doing this on purpose and counting on providers keeping poor records and believing claims have already been paid, when they never cut a check for them to the provider. They need another class action suit filed against them.

Upon speaking with the lady who only does referrals, she explained to me that UHC has two fax numbers, one for routine and one for urgent. She stated that she had indeed faxed it over on the 10th. So I again called UHC and spoke to a woman who had to transfer me because she could not access any of that information. Upon waiting almost 10 minutes, I was finally connected to another woman. This lady said that she did see the fax but that it was not sent over urgent and urgent faxes take 24 hours to process and routine take up to 5 days. I simply stated to her that well, since I was on the phone with her and I was the patient she could rectify the situation and approve the referral. She could give me the referral number so I could make the appointment.

This lady had some nerve to tell me that the patient "doesn't matter" and that I needed to get back on the phone with the doctor's office and have them re-fax everything or call and speak to a UHC rep. After calling the doctor's office again, I found out that it was re-faxed on the 11th to the Urgent line when the office opened at 8 am. On the 17th of April, my regular OB office called me and explained that she had called UHC once again and was told that the referral was approved on the 11th of April.

So here we are today, the 29th of April and I have yet to get the actual faxed approved referral to the specialist office. Why have an Urgent Referral fax that is sold as only taking 24 hours to approve? This situation still has yet to be resolved.

On Friday, April 20, 2013, I received a letter of denial for the dates of service of 11/13/12 and 11/19/12 for dental services for my two daughters performed by Dr. William **'s office in San Pablo, California. When I phoned United Healthcare Dental to inquire about the denial letter, I was told that if I were to write a letter stating that my insurance is primary, then they will pay their portion of the claim (since there is coordination of benefits and my husband's insurance has already paid their portion). I don't think I should have to write a letter since they should have paid this claim months ago.

Here is a narrative of my brief, totally unsatisfactory experience with United Health Advantage since I took this plan in January 2013: Beginning soon after my plan became effective in January 2013, United Health sent reimbursement checks to my physical therapy provider instead of to me. I called about 10 times, asking always for a supervisor, and got different information each time I called about how the checks could be redirected to me since I paid weekly for all services rendered. Clerks told me the forms were filled out wrong by the provider (a box indicating that the provider accepted assignment was left unchecked, which the provider said indicated the checks were to come to me). One man even insisted that providers never filed claims, leaving that job always to patients. One woman told me that I should have written a letter to the company before service started, specifying that I paid for all services as rendered and asking that the reimbursement checks be sent to me.

In the long run, after I terminated therapy at that clinic, I demonstrated to the provider that my payments, plus reimbursements from United Health that went to the provider, exceeded charges. I demanded and got a refund. This all could have been avoided if United Health had acted appropriately on my first phone call, asking how to get the checks sent to me. My new problem started occurring as I tried to find out how to find a dentist. I called and was transferred to numerous extensions, including the medical line, before getting a man with a Middle Eastern name who assured me he would email a list of in-network dentists to me. He told me during the conversation that he had already sent it. Later, when I checked email to get the list and choose a dentist, I discovered that no email had come to me.

I called back but the office had closed. I despair at trying to deal with this company. Several of the people who answered the phones speak English so badly that I barely understand anything they say and have to ask for constant repetitions. Many seemed unfamiliar with standard health insurance terminology or practices, indicating that their training is inadequate. I want to change companies as quickly as possible. Dealing with United Health is a nightmare. I am an active AARP member and volunteer, and I will do everything that I can to get AARP to re-examine its decision to recommend United Health. We can surely find a more competent partner. My experience with Mutual of Omaha's company, United of Omaha, was totally free of the problems I have with United Health.

I have very bad veins in my legs. I have varicose veins that are extremely bulged. They cause severe pain in my legs and I have problems with day to day activities. One of the veins in my left leg ruptured leaving a very large, deep ulceration. It became infected several times causing me to go to my primary physician. It was not healing properly and my legs are getting worse. My regular doctor sent me to a vein specialist. On January 2, 2013, I had an ultrasound on both legs at the Vein Center. The ultrasound showed I have venous reflux. The valves are broken in both my legs.

On 1-23-13, I had a consultation with the specialist and he said that I needed surgery on both my legs to correct the problem or it will get worse. I was scheduled to have the left leg done on March 14th and the second leg completed on March 28th. The doctor's office began the process of preapproval. That was when it started going downhill really fast.

On 2-7-13, my doctor's office spoke to a representative from UHC and sent my information to UHC, including the ultrasound report. On 2-12-13, a UHC RN called stating that there wasn't enough information to approve the procedures. On 2-13-13, the information was re-faxed and my doctor was told by the RN that it would have to go to the review board. On 2-20-13, a peer to peer was performed between my doctor and UHC doctor. My doctor was told that everything seemed in order; it was just that they hadn't received a copy of the ultrasound report. This had already been sent to them two times, on 2-17-13 and 2-13-13.

My doctor was given an approval number. I have a record of that number, but I am not going to post it on this open forum. My doctor was told to send the information to the UHC doctor again on a secure email and to include the venous duplex ultrasound again. This was done and after this, my doctor's office couldn't even get anyone to speak to them. They sent a notice to my doctor's office denying the procedure as medically unnecessary (seriously?).

I already took the time off work to have surgery tomorrow. They are still screwing around. My doctor reported them to the Better Business Bureau. I reported them to my employer who I am insured through. I am getting documentation and filing complaint with the state, the AMA, etc. I suggest anyone who has problems with them to do the same.

The fact that they can't seem to hang on to anyone's information proves one of two things. One, they purposely lose information to avoid paying claims - total fraud. Second, they are extremely negligent with people's private information which is in violation of federal law. In my opinion, their business practices are illegal. This is positively the absolute medical insurance I have ever had to deal with.

When I asked to speak with the supervisor, I was told that there was no one available and they did not know when there would be someone available to call me back. So far, I am very unimpressed with the knowledge and customer service at Member Services of United Healthcare. I contacted the main office in Chicago and they were extremely knowledgeable and helpful. Just a tip for anyone else who tries to call Member Services with a question.

I called United Health Care a lot and would not let me talk to a supervisor and I told them several times I wanted a doctor who didn’t go through Welmed, but they wouldn’t help me and all they did was go around the whole subject. I was better off going through the Christian free clinic and prescription program than to have Medicare and this insurance. Now, I have no doctors or prescription help or anything because I will not use this insurance or Medicare.

I called Medicare complaint department and the State of Oregon yet again. If I were rich, I would pay for my care. I'm not rich; I'm poor. I had cancer. They never paid for any meds or doctor visits. When will the government help us poor people? I was told on the phone if I was to gain 120 more pounds and was in bed rest, they would pay. What the heck? I have kids and don't want to be in bed resting. When I call, I get put on hold for 145 minutes. What? And they disconnect me when I tell them I want a manger. It is not fair. The meds I need for 30 days is worth $1,271 and that's one of three I need. The other is $489 and the other is $200. I bet if anyone in the government gets treated like I did, they would fix it. So do your job. No wonder people lie and rob to get the help they need. People in jail get all 100% care paid for.

I do have COBRA and my policy was supposed to cover ER visits. However, United said only "trauma" was covered in the ER and heart attack, stroke or other problems, like bleeding, were not trauma. They insisted my policy did not cover going to the ER for bleeding. They read me a dictionary definition of trauma and said my case did not qualify. The customer service adjuster said, "This claim will not be paid."

I have been going to my doctor for 9 years and now they want me to go to who they say. My wife and I are paying for a PPO, not an HMO. Why can we not go to the doctor of our choice? What is worse is the health providers that they now are telling us to go to have the worst reputation in the Bay area. They obviously will work for the peanuts this insurance company wants to pay. If UHC is forcing me to go to an inferior provider, then they take the responsibility of my health care and can and will be held liable for any malpractice that I receive through their preferred providers. Now I must start out with a new doctor that has no history with me and he will not be able to provide me with the standard of care that I am used to and am paying for.

It's obvious that UHC cares only about the dollar and not their customer. If you are an employer and thinking of signing up with UHC, run the other way. Your employees' health will not be their focus. Pretty obvious by the position they have taken with Bay Health Care Systems.

When I wrote them to appeal their decision, they wrote back stating I had "cheaper options" and the procedure was "not needed." The coverage does not state the bill will be paid if UHC agrees with my decision! I am so tired and frustrated that insurance companies are running our healthcare in this country! We pay our premiums, yet they decide which medications we can take (basically generics that don't always work as well as the branded) and which procedures they will pay for even though the procedure is covered. They don't seem to answer to anybody and can do whatever they please. The insurance commissioners certainly do not seem to care. I'm pretty teed at this.

I was a Nursing student and worked 16 years at the same company. I am unemployed and can't start class. I am just stuck waiting for help, but no one can help me and I can't get in with a preexisting medical condition. So I have insurance that is stealing from me. That's is exactly how I feel about what they are doing. Their answer is agents and brokers always do that and you have to read the terms and conditions in the book that is 150 pages of rules that contradicts everything the agent said verbally. It's a racket, and they need to be stopped. Golden Rule United Health Care have the worst of criminals.

Upon calling United Healthcare, I was told there was no mistake. United Healthcare informed me that they had made a decision to raise the copay of the generic Singular to $50.00/tier 2 and the non-generic Singular to a $90 copay/tier 3. I am mad. It seems to me that this company is only concerned about making money. I am paying the same copay that I have been paying all the time although this is a generic drug. They do care about a consumer like me who has about 6 prescriptions I must refill once a month. I cannot wait until open enrollment.

I talked with Charles of UMR on April 30, 2012. Charles said WakeMed is not in the network and so the plan covered 70%. I told him that it is not true; the website does show that WakeMed is in the network. I talked to Shannon and others with UMR on 5/16/2012. They were lying with a new excuse that was different from Charles'. They told me that UMR covered 70% due to it being non-True Emergency. That was totally lying. The Emergency visit was truly an emergency and I have the medical records.

Finally, after doing some research, the CS rep indicated that her supervisor told her that we paid a higher co-pay because we did not comply with a UHC policy called the "Adherence Incentive policy". Apparently, because we did not fill the prescription at the end of the 90-days, we get charged the additional $50 for a tier 3 medication. We asked where that policy was published on the website, in the plan documents (SPD's) or on any of the prescription paperwork. The UHC CS rep then informed us that the policy was not written or any notice was published informing us of the terms. We asked then how we are supposed to know how to comply and what the deadline is to refill a prescription so that the higher co-pay would not be triggered? The CS rep said we would not know until the higher co-pay was charged after the fact.

We were dumbfounded that UHC would implement such an unwritten policy to charge a higher co-pay without notifying members of the terms of such a policy so that we could comply. We have filed appeals and complaints with the NM PRC and will not let this action go uninvestigated. People complain about a so-called government interference with business. This is the very example why we need oversight of health insurance companies to protect the rights of consumers and regulate absolute idiotic and patently unfair actions by insurance companies.

I called the number for United Healthcare on the back of my insurance ID card. I was told that United Healthcare would approve me for (3) 5mg ** per month and the cost was $12. I told the representative this was unacceptable. I asked who gave United Healthcare permission or the authority to do this. I was told to file an appeal in writing to United Healthcare, N-Appeals, P.O. Box 30573, Salt Lake City, UT asking for concessions regarding my 30 5mg ** prescription. Can anyone explain to me how or why United Healthcare can dictate how many ** I get in a month? I am insured through my wife's employer. Her employer can fire her without cause. Our monthly premium is over $900 a month. I believe something has to be done to hold health insurance companies accountable to their customers rather than just their shareholders.

It is June 7, 2012 and I still do not have my medication and here is why. You guys have set up a prior authorization form that needs to be filled out in order to receive certain expensive medications. There are no generic brands for this medication as of today's date. So your company has opted to change my prescription to something that is similar. I find this practice to be reckless, the reason being even though you do have nurses working there to find out which medication can be a "possible" substitute, you have no statistical data (i.e. blood work, weight, medical history) along with the information. How can you make an assumption on what may or may not work. The doctor's office as well as the pharmacy have taken your twenty-four to seventy-two hour rule as their own, meaning it's hard for me to even get them to start the process because they flaunt your rule in my face.

I thought that was an error on their part and by rights it is, but then I have come to realize the reason why it takes them so long to place a call. It is aggravating to deal with your company. You have them calling all the time for nothingness and quite frankly people have better things to do. You have them calling for a prior authorization for this and that and every time they call you, it is a battle to get the medication that the doctor prescribed. The doctor even has to get on the phone at the time to explain his/her diagnoses. You do this with no MD, bravo and kudos to you! You are so concerned about saving a few dollars that your insurance company has shown that you have no regard for your customers or their well-being. You are a "health" insurance company! So why don't you start putting your clients' health first? There's a thought for you; run with that.

Oh, and by the way, I know this is a "Medicaid" plan but I'm still your customer. I do not feel that your other customers get treated any better, and if your company graphics keep showing a loss in capital, I assure you, this is why. I'm sorry but please do not respond with the standard corporate letter of "I'm sorry for the trouble, I assure you, value our customer, you are important to us," you do not mean it and I do not want to hear it. I just would like an acknowledgement that the letter was read and forwarded on to the right place if need be. After this letter was forwarded, I received an email that basically said contact someone else.

The insurance company said that since she's not on insulin, she doesn't need to test her self that much and only okay-ed 50 test strips. Now that's not even enough for 2 weeks, not counting your control strip or any errors she may get. We have gone through all the hoops and whistles getting the doctor to call the insurance company. United Health told the doctor her phone call wasn't good enough and that she needed to send in a written explanation, which she did. Then they told her she had to fill out a form, which they faxed to her. The doctor did this and faxed it back.

United Health Care, now a week later and my wife is running low on test strips, is still saying that it's processing. I asked the manager on the phone if she was a doctor, and she replied no. Then I asked her what gave her the right to override a doctor, who had gone to medical school and had more experience in the field than she did. She then changed the subject saying she was going to check on the status of my wife's paperwork. The next thing I knew, the phone disconnected. Wow really, you get put in your place and then you hang up on a paying customer.

How can an EMS service even be in business if they are not in network with the major insurance companies? With a dying husband in my arms, I'm not about to ask if they are in network, I have never heard of such a thing. I have refused to pay the bill and United said that I can appeal it. I shouldn't have to appeal something like this! Two agents at United that I spoke to said they felt the claim was processed incorrectly and out of network doesn't apply to 911 calls, but when a supervisor intervened, she said it was processed correctly and I can write a letter to appeal. They have paid every surgical procedure, every medication, the ER when he was rushed there on his last night on this earth, but they won't pay for his ambulance? Someone please explain this to me because it's causing me such distress.

In February, I went to the doctor for a sick visit. I paid a $30 co-pay. Again, I got a bill for $77 in addition to the co-pay and the monthly payments. And this was for a sick visit! Now they tell me I have no more co-pays once I meet my $400 deductible. My husband's is $400, then we each have to pay 20% of cost and they will pay 80%. Who comes up with this stuff? They do not cover us. We are paying them for nothing. There is no coverage. The only thing we are getting is runaround and hassles! People need to get together and file a lawsuit against this company!

Paper claims are being denied stating our billing software is off a line per UHC templates. No other insurance company is returning our claims telling us we are offline. It is only UHC that is denying these claims and will not pay them until we realign them. We have no way to do this as our software is set and again the hundreds of other insurance companies we are sending to are having no problems.

We are constantly fighting UHC with their understanding of the A0426 and A0428 procedure/HCPCS code denials. Patients call and complaining even have had UHC representatives calling us telling us we need to change our billing to get the claim paid. Every single claim with one of these codes has to be appealed to get them paid. We are told they are following the CMS rules and regulations. If this is the case, why is Medicare paying the claims and UHC is not? We are a billing company and represent over 250 providers. UHC plays more games to delay their payments going out the door within 30 days.

I called back again and couldn’t get an answer so I asked to speak with a supervisor. One called me back and after spending another hour on the phone with them asking why my card from them says insured by United Healthcare on it and they claim I am not insured with them, finally, the supervisor from United Healthcare called me back. She sounded nice in the beginning, but never explained why 2 of their representatives said I am not insured with them, just a lot of empty "I’m sorry". I spent another half hour on the phone with her trying to find out where to send my bill to them. I never got an answer after asking that 7 times, only told that I can’t send it in until I receive a form from them to fill out; that has the address on it. Then, she tried to find out if they would even pay for the service my bill is for (by law they have to), but she was very unsure.

I finally insisted after using up all my cell phone minutes that they send me the form and still had to wait a long time for her to. I had already told her that by law, their insurance company has to pay for this service, but she just blew that off also. There are so many communication problems there and they don't even care. I asked if I could get reimbursed for all the cell minutes I had to use, Kelly said they would send me a reimbursement form, but I’m sure that I won’t get reimbursed because of all of the confusion.

I should have the right to continue to go to my pharmacy without being punished for not joining a mail order program. You are not taking into consideration what each individual goes through. I make too much money to qualify for any assistance, but I am barely surviving being a single mother. I am the only person that supports me and my daughter. We get no child support, no state assistance and no breaks for daycare or anything else. I am highly upset and disappointed with this insurance. I feel like I am being raped, and I do know what that feels like. You are giving me no choice.

I want a call back from a senior manager at United Healthcare and I want my pharmacy prices to remain the same as to what I was always paying and I want to continue to go to my pharmacy. I do not wish to be a part of a mail order program. I want my medications when I want them and at my convenience. This is not good medical practice for an insurance company. I look forward to hearing from someone that can solve my problem; otherwise, I will look into other options, such as, contacting the local TV station about what you are doing.

I'm sure I'm not the only one in this situation. I will also start a website about these unfair practices and possibly start a public protest. I am a hard working single mother with a lot on her plate and dealing with a bully of an insurance company is not something that I want to be doing. But I will! I will stand up to you. And if that means not taking any medications so that we will have more hospital trips and more doctors visits and possibly death, then so be it! Because then there will be a lawsuit right behind it. The nerve of you at United Healthcare forcing people to join something they don't want to and the only other choice they have is sky-rocketing prices at the pharmacy. You should be ashamed of yourselves! Please, I look forward to my call back from a senior manager in regards to a solution that is keeping my pharmacy prices the same as I have been paying in the past.

When I got to the window, I was told that "The insurance company will not cover this because it is from a retail pharmacy. In order to have your prescriptions covered, you will need to go through a mail-order pharmacy". At this point, I wasn't worried about running out of my medications because I had enough samples of both Levemir and NovoLog to get me through the waiting period while the paperwork for the mail order pharmacy went through. Though I was a little irritated with it, I left the pharmacist in good spirits and didn't worry about it. Just to confirm this, I called United Health Care that Monday and sure enough; the lady on the phone told me exactly that. I had the mail order pharmacy, Medco, in mind so I wanted to make sure they were an approved pharmacy where I could get my prescriptions filled. I live in an apartment building and though I did not like the idea of having my necessary medications mailed and put in a hot and stuffy office, I was willing to comply because I had to have my medicine. I called Medco and got the necessary prescriptions and paperwork from my doctor's office and faxed all of the forms to Medco.

It wasn't until 3 weeks later that I received a phone call from Medco stating that the insurance would not be covering this and I would have to come up with $689.50 in order to pay for the prescriptions. When I told them that I had health insurance through United and they told me that I needed to go through a mail order pharmacy in order for them to cover the cost of the medicine, they said that the health insurance would not cover a dime of it.

I was absolutely beside myself when I called United and told them what was going on. It was at that point where I was told that I would need to reach a $2,500 deductible in order for them to pay for my medications. When I asked them why no one had told me this when I called to discuss what pharmacy I could use to cover the cost of my medicine or any of the other times when I called them to discuss the policy, the representative was speechless and could not give me an answer. At that point, I told the representative that they were going to end up screwing me over and putting me in a position which I can't get out of. I did not have $250 to pay for the medicine at the pharmacy, let alone $690 to pay for the medication through Medco.

I ended up having to borrow the money from my boss and going to the doctor nearly once every 2 weeks just to reach my deductible (in addition to getting more samples from him). In the end, I still fell short and didn't reach what I needed to hit in order for the insurance company to cover my medication. I would have been better off not signing up for benefits at all! The one thing that was covered was doctors’ visits, not including the lab fees, tests or anything else that was needed. All of the hoops and anger could have been saved if someone at United would have just been honest with me and said that I need to hit a deductible before the cost of my medicine would be covered. It is a shame that I had to pay for a policy that didn't cover anything! It was just as bad as not having health insurance at all.

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.

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!

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 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?

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?

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?

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.

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.

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.

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.

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.

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.

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

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?

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!

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.

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.

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.

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.

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.

I have lost coverage was told today to refax again to a supervisor named Ms. Sam in Cobra department at 866-525-1740. I have not had my meds again because of them the last time they caused an issue for me. I was admitted because they delayed paying my long term dis. I was treated with nothing but disrespect by a lady named Susan **. I had to do all the work, have doctor information sent 4 and 5 times to her attention before I filed a complaint and still they only approved the dis for 3 months at a time although I can hardly speak, so someone can understand. I am so behind in all medical because a company I worked for for 13 don't want to pay me for services I have been paying into for 13 years. I also asked about my severance told me they only give when prof serv lays off people this is not true they are still hiring and supervisors. Prof serv reps who have been laid off have received as such when I asked for a letter to be sent to tell me why they refused.

When I asked for a supervisor or manager to call me was told no but when I asked if I need a lawyer or something to that nature, told me someone from HR would call. It has been more than 30 days by the time this is received. I may be back in the hospital. I have no more meds for angina, tia, copd or my arthritis. Please help people need to know what is happening with this company. This is the most horrible thing I have ever had to be subject to in my life. Even you can't help me. Please make sure the rest of the people who work for them, don't have to continue on this path. I have gone through mental health issues since I have been ill, I can't even continue on my meds for that. God Bless and thanks for listening.

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.

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.

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.

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

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.

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.

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.

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'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.

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.

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.

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.

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."

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.

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.

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.

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.

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 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. ** are not the same drug!

Then I found out the reason for this is the newly put on the market generic version of ** 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 ** 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 **? 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 ** 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!

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.

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.

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.

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 conversation 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 publicly 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 **. She has yet to return my call.

I need to go through an appeal 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.

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.

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 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.

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.

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.

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.