UnitedHealthCare Reviews

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.

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.