“Your drugs are too expensive.”
That’s basically what United Health Care had CVS tell Kelly when she went to get a scrip filled. Kelly has taken the meds for three years. Her past two insurance companies covered the prescription without fail.
Now United Health Care has decided the drugs are too pricey, and, “…since a generic is not available, they’ve decided the best way to prevent paying too much for their clients’ medication is to put limits on how many pills they’ll pay for per client, per month,” she writes.
Kelly needs to take 1.5 pills per day, 45 pills per month. United will only cover 30.
That’s not the worst of it.
The pharmacist told her that if the pills are a medical necessity, as they are, she should have her doctor call the insurance company and explain the need for the medicine.
Kelly said to the CVS pill pusher, “An authentic written prescription from a medical doctor is not proof enough of medical necessity but a phone call with no real explanation will make giving me 15 more pills OK?”
The white coat affirmed this was correct. In addition, if United ultimately determines not to cover the 15 pills, the cost would be $50.
This practice seems pretty ridiculous and arbitrary on United Health Care’s part but we have to ask, if you’re going to switch providers, shouldn’t you find out whether they cover the medicine you’ll be needing?
Kelly’s letter is inside.
Kelly writes:
- “My Dearest Consumerist,
Armed with a brand spankin’ new UnitedHealthcare insurance card, I headed to my local CVS to fill a prescription. I’ve taken this particular medication for the last three years and my two prior insurance companies never gave me any sort of hassle where this medication was concerned.
I handed my prescription and my new insurance card to the pharmacist and he told me it would only take a few minutes to process the new insurance. A few minutes eventually turned in to fifteen before he came from behind the counter to tell me my insurance wouldn’t fill the entire Rx. Obviously confused, I asked him to please elaborate. As it turns out, this medication is deemed too expensive by the insurance company and, since a generic is not available, they’ve decided the best way to prevent paying too much for their clients’ medication is to put limits on how many pills they’ll pay for per client, per month.
My Rx called for 1.5 pills to be taken daily, meaning 45 pills would be needed for an entire month’s supply; United will only cover 30.
I further questioned the pharmacist as to what I could possibly to do get United to cover the medication, as it’s absolutely necessary that I take it. His explanation, essentially, was this: call your doctor’s office and have either the doctor or a nurse phone the insurance company. All they need to do is explain that the medicine prescribed is medically necessary and, 9 times out of 10, they’ll approve it.
So I said, “wait a second. An authentic written prescription form a medical doctor is not proof enough of medical necessity but a phone call with no real explanation will make giving me 15 more pills OK? That makes absolutely no sense.” The pharmacist apologized, agreed that the system was backasswards, and also told me that should United not cover the additional 15 pills, I would have to pay roughly $50 out of pocket for them.
$50 is certainly not going to break the bank and I’ll pay it if I absolutely have to. I understand that healthcare is expensive and that maybe, to some degree, the insurance companies MAY have to cut back in some areas. I, however, don’t think it’s right to say that a prescription for a medication used to treat a bona fide illness isn’t enough to have said prescription filled. It utterly baffles me!
Just thought I’d share another consumer’s plight. Hopefully there aren’t too many other people out there with similar situations but somehow I doubt it!
Love always,
Kelly”
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That’s great, MonsieurBon. Mine wasn’t through BC/BS. I think it was from “Crazy Bob’s Discount In-Case-You-Get-Hit-By-A-Bus Insurance.”
I work as a claims processor for a health insurance company. You folks saying that health insurance companies are evil, well, I’m trying not to take your comments personally. Think of all of the posts made on this site where a commentor states they work in retail/customer service, and totally ditch the scripts their company gives them. Every claim I pay, I try to give the doctor/member the best benefit I can.
BUT, like any other customer service situation, if the doctor or patient is not completely honest, or doesn’t provide all the information I need, or simply doesn’t follow the rules of the plan, what do you expect me to do? We already have a policy in place to try to contact the doctor by phone for the information, but when your doctor’s office doesn’t open until 10am, closes at 4pm, and is closed Fridays…. There are plenty of people at your insurance company who are trying every day to do the right thing. I am bound by company policy just like all of you are bound by your company’s policies.
COVERAGE. Many employer-sponsored health plans are self-insured by the employer. What does this mean? It means your employer has a bank account somewhere, and all of the money that gets paid on all of the claims for all of their employees comes out of this bank account. Your company has hired the insurance company as a third-party vendor to administer the benefits, because they have the people in place to do it cheaper than your company could.
Big companies do this. Smaller companies are ‘fully insured,’ which works just like your car insurance. You pay a premium, and the insurance company pays out the claim dollars.
If your health policy is set up like this, it means that some HR flack in your company decided what was going to be covered and at what rate, not the insurance company. This also means that the insurance company doesn’t have to follow all of that state legislation you hear about in the news.
Do you realize how much time/effort/money my company has to spend, getting me the requisite training on all of the new health legislation that comes out? Part of the problem is that health insurance is being legislated to death.
RISK. Health insurance companies can risk-asses, but only on individual plans. That’s why the applications are so personal, and they’re so picky about past problems. The health insurance company is trying to make up for not being able to risk-asses with their group plans.
POLICY TYPES. You can buy just about any type of coverage you would like. If you need a plan that covers prescriptions – its out there. Want a catastrophic-only plan? It’s there. Want a preventative-only plan? There’s one of those, too. Unfortunatly, you’ll have to go to a broker and buy an individual plan if your employer doesn’t offer what you want, and your premium won’t be subsidised by your company.
Yes, there are problems. Some of the people I work with are flaming idiots. But please don’t assume that it’s all a big conspiracy. My benefits are being cut, too. I have a $1500 deductible and no copay on my employer-sponsored health plan.
All I have to say is
1) When I changed employers, I actually was let go from a nonprofit that had a great plan and I began working for the goverment who had United Health Scare, I panicked.
Welll I recently suffered a near fatal illness and became my own advocate. I have fought United Health Scare and amazingly won thus far all the battles. They have not fought me for any of my health care needs including my drugs or therapy.I however remain skeptical and will continue to call them United Health Scare.
2) I agree that changing political parties is not the solution. Each individual must fight their own plans for what they beleive is their right. Also, privatizing our health care in the United States has been one of the greatest errors of all times. I say let government handle it, what do we pay our taxes for. We are presently at war and if our own veterans can not get the best health care assistance along with financial assistance, what does that say about our country
The state of Georgia moved all employees, not choosing a HMO, to United PPO at the beginning of 2006. After a year under their payment claims, I have seen a double in the amount of out of pocket expenses and total ineptness in their payment of claims. I am currently appealing their most recent refusal to pay valid claims and many good doctors in this state refuse to take their insurance. I hold out little hope that they will pay my claims. I understand that when McGuire was forced to resign last year that investigations were proceeding at the federal and state levels. I hope they go the way of Enron and other corporate crooks. McGuire, the fired CEO, made over $1.2 billion prior to being fired and may face jail time. New York no longer allows them to operate in their state. The corporate officers have made huge contributions to Republican candidates over the past 20 years. If you have a choice, go with another company!
This is the best compilation of information- I too, am a victim of United Health Care. Just recently- They have made it impossible for my Dr. to follow authorization rules- they “lost” the fax that THEY REQUIRED HE SEND. HE personally and his office manager spent 4 HOURS On the phone this past Friday on MY CASE. I called and it took me 30 minutes to get from point a. to a hang up, telling me that they couldn’t help me because they hadn’t denied my claim yet–I played dumb of course- denied my claim I asked, how do you know you’re going to deny my “claim”.
This is almost a perfect scenario- I happen to be a insurance industry professional who has worked inside and out of HMOs as a consultant all over the country- Nothing to be proud of, but amazing to be on the other end knowing what I know.
It is no coincidence that they are efficient enough to HAVE A LETTER WAITING IN THE MAIL ON THE DAY I WAS RELEASED FROM THE HOSPITAL-THEY WANTED TO KNOW THEY “CARED ENOUGH” ABOUT ME to let me know they knew about it- yet they can’t find the authorization. Which of course is their way of saying- even though you have paid premiums and have never been hospitalized you are screwed. By the way, my small, great company that I have been working with for fifteen years pays a fortune for small group insurance- We switched from Blue Cross to UNITED HEALTH CARE this JANUARY- Big mistake- they were all too happy though to reel us in by under cutting Blue Cross by several thousand dollars a year. We should have known better!!!!!
However, as a professional in the Insurance Industry (believe me I am not proud of it anymore), you must all know that you are dealing with a CRIMINAL COMPANY. The former Chief of United Health Care is Dr. William McGuire- Google him- he was asked to “step down” in Dec. of 2006 due to SEC Investigation that PROVES he acted illegally, profited from it . And Martha Stewart was put in Jail?
Bottom line is–blogging about it is not enough- I found this by accident when I was searching for information as to whether it’s legal or not for an insurance company to check member’s credit- to see who actually has money and who doesn’t–Blog and do more – TELL EVERYONE, report UNITED HEALTH CARE TO THE Better busiiness bureau- it’s the same as voting, they are banking on us thinking that we are just one stupid member- THE SYSTEM THAT PUTS YOU ON HOLD, CUTS YOU OFF and causes you to feel like pounding someone there IS NOT AN INEFFICIENT SYSTEM- IT IS A VERY ELABORATE AND EXPENSIVE COMPUTER SYSTEM DESIGNED TO FRUSTRATE YOU AND DOCTORS SO THAT THEY DO NOT HAVE TO PAY OR CAN DELAY-THIS IS A FACT THAT CAN BE PROVEN. THIS IS A FACT- – WRITE SENATORS, CONGRESS, ETC. That’s what I am going to do-
WILLIAM MCGUIRE M.D. is LIVING A VERY WEALTHY LIFE IN MINNEAPOLIS, MN. He probably has had to change his identity to protect himself! He probably has personal body guards. HE HAS PROFITED ILLEGALLY AND SHOULD BE IN JAIL. HE CONTINUES TO PROFIT FROM THIS AND WILL FOR LIFE- LOOK AT HIS AGREEMENT WITH UHC- IT’s PUBLIC COMPANY. UNTIL INSURANCE COMPANIES ARE BARRED FROM GOING PUBLIC THIS WILL CONTINUE–IT’s very SIMPLE, BUT WHY SHOULD OUR GOVERNMENT do anything ABOUT IT-THEY are PROFITING FROM THIS.
All of these should be cut and pasted to letters and sent over and over and over again to everyone- I would pay for the postage out of my own pocket! Insurance companies are legally obligated to acknowledge appeals- the guy who wrote about learning about this in his MBA class is sorely mistaken- UHC has spent millions of dollars on their computer systems, designed not only to screw the members, but the providers. I analyze provider contracts as a consultant- most of the HMO’s and insurance companies cannot even put their hands on the source documents- unfortunatley, the providers themselves are not even sure of what they have signed until it is too late.
About a week into January of 2007, I received a letter from United Health Care that they would no longer cover long-term medicines that were bought at any pharmacy other than Medco by Mail. This letter included instructions on how to make purchases from that company. I gave the fax number of Medco, along with my relevant insurance information, to my doctor’s office and asked them to send my wife’s prescriptions.
A week later we received the prescriptions, but there were problems. First and foremost, one of the medicines was incorrect. My wife needs Metformin Extended Release, but she received plain Metformin. Secondly, the amounts on two of the prescriptions was incorrect. Rather than a 90-day supply, we were sent 90 pills. On one of the drugs this would last 45 days, on another of them it would only last 15 days.
The customer service representative of Medco was supremely unhelpful, claiming that they filled exactly what the prescriptions called for, and disavowed any responsibility to make things right. My doctor’s office has agreed to cover the cost of the incorrect prescription, but if they had not stepped forward I would have been obliged to pay for medicines which we could not use.
I have occasionally experienced similar situations with Walgreens, but have never had to accept the wrong medicines, nor incorrect amounts. They always corrected mistakes on the spot.
To make matters worse, there seems to be no middle ground when it comes to daytime telephone calls from Medco. They will either call about every inconsequential step of filling the prescription, or they will not call at all. “Only call if I am needed to authorize something” does not seem to be an option. As a 3rd-shift worker, I find this completely unacceptable.
The company I work for has taken away all choice of medical coverage with the exception of United Health Care (or “none,” which is of course not a viable option in today’s world). And UHC has taken away all choice of pharmacy other than Medco. When you add to this the fact that the pharmacy from which I am being forced to buy pills is costing more than I was paying before, this amounts to yet another effective pay cut for me, and very likely many other employees. This is certainly not what I expected after “upgrading” to a UHC policy with premiums more than twice the levels of the plan I previously had.
Early in April I had to re-order medicines from Medco. When they arrived I learned that two of them had been replaced with generics without my permission. The accompanying letter stated that the change had been authorized by my wife’s doctor.
The doctor’s office told a different story. They remembered the call from Medco. The office staff spoke to the Medco caller, and deferred the decision to the patient (my wife).
No one from Medco ever spoke to my wife about this, nor to her doctor, nor to me. If they had, then they would have learned that my wife has had serious side-effects from past attempts to substitute another medicine for that which was prescribed.
Once again resolution of the problem proved to be difficult. Medco claimed that they could only replace one prescription at a time. pending payment, blaming the cost of the pills for this decision. After much debate and negotiation, my wife decided, against my advice, to try the generic brands, on the condition that they would be replaced should any problems ensue.
I remember when this company offered multiple choices for health care coverage. It was part of the cafeteria plan which was touted as an excellent employee benefit at the time. I also remember that each different plan carried a different level of employee contribution. When I was forced to choose between United Health Care or no group health coverage at all, my personal contribution to health insurance premiums increased dramatically as level of service decreased reciprocally, although the company claims that lower costs for employees was the reason for the change. Perhaps the company is saving money, but with my costs increasing fourfold, I hope to be forgiven if I am skeptical that this change in employee benefits was in the best interest of the employees.
In any case, lower costs mean nothing if the level of service is worth nothing. If Medco cannot be trusted to gain proper authorization before making changes to prescriptions, then they cannot be trusted to fill prescriptions at all. Lack of competition – and regulation – has made these providers lax and uncaring. Because we cannot take our business elsewhere, Medco feels no pressure to improve customer service.
United Healthcare is flat scary!!! They are the largest health insurer in the country now, insuring millions of people and have a corporate attitude that they are beyond regulation. They have been examined and fined by almost every state insurance department and by the Feds for Medicare fraud in Florida. They are all about getting bigger and bigger, not at all about providing service to their clients. They view claims as a necessary evil hurdle in their quest to become even bigger. I have been in insurance regulation since 1974, I have examined United, they scare the hell out of me. They are aiming to become THE MAJOR PLAYER when National Healthcare becomes a reality….which should scare the hell out of you too. Hopefully I will be dead before this happens.
BB
My family and I are on terrible United Healthcare medical COBRA insurance. After our newborn daughter was born in June, we notified them by phone two days after the birth and requested that she be put on our policy. They said that they need proof in the form of discharge papers or birth certificate. Since with the birth of our other children the discharge papers were not required, they were misplaced during the chaotic time after coming home from the hospital. The birth certificate came a few weeks later with an error in the names. So after receiving the corrected birth certificate (2 weeks later) from vital statistics of the city and promptly faxing it to UHC, they said that it was 4 days past the 30 day deadline for adding a newborn to our policy. We didn’t fax the inaccurate birth certificate to UHC for fear of corrupting our newborn daughter’s identity records. On top of this I was still in my 45 day open enrollment period in UHC COBRA. They are refusing to add our infant daughter to our policy and we are beginning to get ridiculously high bills from the hospital and pediatrician. UHC personnel gave me weeks of run around on the phone, saying they would call back with their response to add our daughter. We never got a call or email from UHC about adding our newborn to our medical policy. After talking to a rude and belittling supervisor, they said they finally gave me a straight answer that they would not be adding our newborn to our policy. So now our infant has no medical insurance, how about that for modern civilization and government in which my taxes go to give medical treatment to criminals and terrorists. I think that UHC is not a company that respects a family, or the difficulties and stresses at the time of a birth. Does anyone have any advice as to how to fight this unfair treatment? Do I have a legal leg to stand on or has UHC screw me again? I think United Healthcare Insurance company has a whole department dedicated to finding new ways to cause hardship to a family, especially the middle class families that probably are not wealthy enough to hire lawyers to fight their unfair policies.
TRITEON said… >>> This is not– a political issue. If your theory on changing this situation is to vote for one party, then why didn’t the Clinton administration and the Democratic Congress “solve” this back in ’92-94? <<<
WRONG… It IS a political issue. The reason Hillary did not get health care reform passed is because the insurance lobbies spent over a billion dollars throwing mud to get the uneducated masses to fear “universal healthcare” (fear word – “socialized” medicine) We have a lot of other things run by the government that work… police, fire, schools, in fact the very agencies that we run to for protection from the big bad insurance companies are often run by… “the STATE.”
Government is not to be feared… not when it is run by the PEOPLE. Politicians need votes and need to see the PEOPLE are behind them when they do the right thing and stand up to these multi-billion dollar corporations. Right now too many of our poor and middle class see voting as a waste of time. THIS is what needs to change.
Universal Healthcare works in every other 1st world developed nation. We are the ONLY country without it.
There are NO Republican presidential candidates who support Universal Healthcare reform so we can take our lives out of the hands of greedy corporations.
Hillary might do it… though she has now corrupted herself by taking the money of the insurance companies herself. Obama has not only called for Universal health care, but PROMISES it by the end of his first term. Whether he can deliver remains to be seen (if elected)… however if all of we VOTERS band together on this one issue… we can make a difference.
READ this…
[obama.senate.gov]
We need to pull our heads out of the sand (or wherever we have them stuck), quit watching American Idol and Dancing with the Stars, and realize that we are letting the rich get richer off the backs of the poor and middle class.. and this is one of the ways we are doing it.
It reminds me of a quote by Howard Hughes… “2% of the population controls 98% of the wealth, because 98% of the people are stupid.”
Do YOU believe that? I don’t. I think Americans are smart enough to see what needs to be done… and smart enought NOT to put their trust, and their loved ones lives, in the hands of fat cat corporate boardrooms.
It has to stop. The rich have no business continuing to get richer through the healthcare system and the lives/deaths of hard working Americans.
Want a better life? Vote for a candidate that promises Universal Health Care. Get DEBT free so you are not enslaved to a job or company you hate, teach your children about debt and credit so they do not enslave themselves… and leave your kids a better country than we have right now.
Let me also point out that while Hillary or Obama might have a better chance of winning… if you REALLY believe we should have Universal Healthcare… Dennis Kucinich is the only one supporting a true (no for-profit insurance companies involved) Universal plan.
[www.dennis4president.com]
He is behind in the polls… but is getting more and more grass roots support every day. Also… he has a lot of research on his web site showing the LIES and misinformation that the American Public has been fed over the years to keep us in the pockets of the greedy corporations.
The BIGGEST lie… that Universal Healthcare would cost a lot more taxes. Do the math… more than 30% of current healthcare dollars go to administration fuctions. THAT would be unnecessary with a Universal system. (no pay – no billing departments). Also… that statistic does not take into account the attorney fees and cost incurred when consumers take on the insurance companies who deny claims. THAT would not happen either with Universal.
So… taxes might go up a LITTLE bit… but what would you rather pay… a little extra in taxes and know you and your family are going to be taken care of… OR… thousands in premiums and then more thousands for co-pays and denied procedures?
Keep in mind… the greedy among us think THEY will never get sick. If you are one of those people who say… “why should I pay for the other guy?” I want to poing out that …one day… you will BE that “other guy!”
You might be healthy today… but tomorrow you could get seriously injured in an automobile accident. Health care is not just about illness… but also accidents and injuries.
Here is another statistic… more than 50% of the people who declared bankruptcy did it because of health care costs. More than 75% of those people… DID have insurance! Today… having insurance does not protect you either. A universal system would!
Looking at how successful the Universal Health care system is in other countries… is is a shame that we have been kept in the dark for so long. We live in one of the richest countries in the world (for now), there is no excuse to have people dying from lack of health care.
Let me also point out that while Hillary or Obama might have a better chance of winning… if you REALLY believe we should have Universal Healthcare… Dennis Kucinich is the only one supporting a true (no for-profit insurance companies involved) Universal plan.
A quick search for united healthcare sucks brought me to this page. sorry to say that UHC still sucks and has rationed my prescription also. how can anyone scare me about Clinton’s or Obama’s national healthcare plan, either one is going to be better than the status quo.
UHC I have been on UHC for 4 months. I cannot even tell you everything that they
have done. I will later. Can’t we file a lawsuit?. Won’t some enterprising
lawyer take it? If UHC gets away with this, other companies could follow
suit.
@LarsElectra: Ditto on UHC. I was denied penicillin prescribed by my doctor. “Not a covered service or experimental” is what I got back. Give me a break!
I can understand why Kelly would be anngry since UHC seems to have their priorities on profits and not people.
Recently implemented, United so-called Healthcare sends out a quarterly statement identifying health benefit plan activity. With about 20,000,000 subscribers, 4 times a year, and let say the minimum postage was the same as mine (34.6¢) the postage cost alone is $27,680,000. The paper, the envelope and the processing have to cost about the same. We’re looking at $55 Million wasted—not to mention the trees—for something of little value which could be sent over the internet IF the individual wanted it. THIS DOES NOT LOWER HEALTHCARE COSTS. Reminds me of their former CEO’s $124,800,000 one-year salary and $1.6 BILLION in stock options over 8 yrs.
To add to the waste on these statements, even if the subscriber is the only member, they list the member every time. For any Type if Service that’s Pharmacy the Provider is always “suppressed for member’s privacy.†The amount of unused space is amazing, the statements could be reorganized to take up much less paper. I complained and asked to opt out, the rep told me I couldn’t and when I asked for a supervisor, the rep said that her supervisor would tell me the same thing. I asked to speak to a supervisor anyway. The supervisor said they were wrong—that I could opt out. He took care of it.
I’m sick of having to opt out of everything. UHC — do it right. Get rid of the waste and ask people if they want to opt in and if they want it electronically. And not where you have to sign in and verify who you are. Send it directly to the subscriber’s e-mail address as a PDF. If you cared about costs, you could send me a postcard ONE TIME offering me options and whether I even want the statement (which I don’t).
I was told by my rep to direct my complaints to UHC at 9900 Brenstreet Rd, Minnetonka, MN 55343. From what I have been able to ascertain the correct address to UHC would be 9900 Bren Rd E Ste 300W, Hopkins MN 55343, phone 952-936-1300.
I’m directed my letter right after I posted this on Mapquest Maps to Midwest CEO Kathryn Sullivan at UHC at that address. We’ll see what happens.
Feel free to call 952-936-1300 and give’em hell. Ask specifically for Ms. Sullivan. If you can’t reach Ms. Sullivan directly, ask for her assistant, Veronica Sanders.