UnitedHealthCare Reviews

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Prescription Solutions doesn't care about your medicine, you, or the quality of your medicine. They are not accommodating and UHC Prescription Solution Pharmacy claims mailing overnight is expensive. Since United Health Care is a multimillion dollar company, I find this excuse to be highly unlikely. Further, Prescription Solutions provides a reminder call that is too early and therefore you cannot refill your medications due to needing a "prior authorization". The stupidity to this is that they don't even know their own rules. If you order your medicine too soon, the health care company denies it and requests a prior authorization. How can they not know a "no-brainer"?

It is up to you, the patient, to advocate for yourself. United Health Care Prescription Solutions Pharmacy will not accommodate you, the "patient." It is all about them, their schedule and their cost at their convenience.

I was re-evaluated by Dr. ** on 9/2008, a uterine ultrasound was performed, fibroid and polyp growths were noted. I was seen by Dr. ** on 10/9/2008, and options were discussed. Dr. ** expressed concern with the growths, as it had only been seventeen months since the previous D&C. A second DNC would be necessary to remove the invasive tissue and the Novasure Endometrial Ablation System was discussed. Novasure destroys the endometrial lining/vascular tissue, preventing the growth/attachment of invasive fibroid/polyp tissue. The D&C and Novasure Endometrial Ablation were performed on 11/19/2008. Post surgical results are positive. Bleeding is almost non-existent and I have experienced no complications or re-occurrence of pre-surgical symptoms.

Health insurance exists to cover medical necessities such as this procedure. I pay insurance premiums to cover this surgery. I pay my insurance premiums to United Healthcare with the understanding and expectation that medically necessary procedures will be paid to my physicians. UHC paid the hospital expense for this procedure. UHC paid the anesthesiologist for this procedure. UHC has repeatedly denied paying the gynecologist for this procedure, yet I pay my premiums to cover her fee every single month. Cost to me of $4,400 and threat of credit issues for non-payment.

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

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

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

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

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

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

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

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

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

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

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

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