United Healthcare Doesn’t Feel Like Paying For Your Drugs

“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”

Comments

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  1. d0x says:

    United wouldnt cover my refill my script for antibiotics because they said I didnt need it yet despite the fact that the very same Doctor gave it to me because the original amount wasnt enough.

    True it only cost me $15 but what the hell am I paying $80 a month for if they wont cover me on the rare chance I actually use my insurance?

  2. KevinQ says:

    Consumerist said:

    If you’re going to switch providers, shouldn’t you find out whether they cover the medicine you’ll be needing?

    Well, sure, if she made the decision. But most people don’t get to actually make that decision – it’s made by their employer to save money. And the insurance company covers their lower price to the company by cutting corners whenever they can – like denying coverage for a legitimate prescription.

    K

  3. Smashville says:

    I ran into the same problem with ExpressScripts and Wellbutrin XL. After 6 months, they said I was “ineligible” for my prescription to continue unless I switched to a (nonexistent) generic. After a couple of months of talking to my doctor, my insurance provider and the pharmacist, I gave up. Needless to say, thanks to ExpressScripts, I’ve been off my meds for a year and a half.

  4. timmus says:

    I think the insurance companies are hoping to eventually cut out the middleman and simply run their own clinics and pharmacies. “I’m sorry, sir, we’re unable to set your broken leg because we’ve deemed it a non- life threatening affliction. Here, we have prescribed you a 30-day supply of ibuprofen. Do you need someone to help you out to your car?”

  5. homerjay says:

    Isn’t it pretty safe to say that you could easily substitute United Healthcare in this example for just about any other insurance company?
    I mean, the only reason you’re not writing this about everyone else is because you haven’t gotten letters about it, but they all pretty much suck equally.

    They’re equal suckertunity providers.

  6. cocodynamite says:

    I’ve been battling Empire Blue Cross/Blue Shield for the same reason. Two weeks ago I went to the pharmacy to have my Lexapro RX filled and was told that Empire only pays for 1 pill a day. My dosage is 15mg so my doctor writes out the RX for 45 10mg pills and I have to cut them (it’s a pain).

    After my doctor repeatedly faxed and called them my RX was finally approved…Of course this was after they tried to switch me to another cheaper drug. During this 2 week long process I was told it would take 72 hours for Caremark to receive a fax (that’s one slow fax machine) So I requested a supervisor…Two days later received a phone call from a customer service supervisor informing me everything was all set with my authorization. So you can imagine my surprise when I went back to the pharmacy and my RX was denied again for lack of pre-authorization. After about 6 phone calls between the pharmacy and Caremark my RX was finally filled. But I went a week without my meds…I basically told Empire and Caremark if I didn’t get my meds I was going to go to the ER.

    The best part is all the gory details ..like the representative at Caremark’s Emergency hotline telling me she couldn’t give me advice because I might sue them. The customer service hotline that gives out false operating hours and being hung up on.

    I’m lucky considering I have half my wits about me but I feel bad for the people that can’t navigate these systems and just have to take it from these insurance companies. I don’t know why I’m paying for insurance and the worst part is they treat you like a criminal when you try to file a claim.

  7. acambras says:

    I’ve said it before — there is a special little corner of hell reserved for these “utilization reviewers.”

  8. OnoSideboard says:

    Ugh, don’t even get me started on health insurance. Every month I send off a monstrous check for my individual health insurance (not provided by work) but every time I need ANY medical care, it somehow isn’t covered.

    In my opinion, the absolute worst is that they refuse to cover my annual “Well Woman” exam (for those of you non-women, that’s the yearly trip to the gyno for the fun pap smear). It’s abhorrent that they would prefer to take their chances on me getting cervical cancer than pay $120 once a year to prevent it. As it turns out, my ins company offers coverage for that ONE exam for an increased rate, which works out to cost me about $200 a year. Obviously it’s more cost efficient for me to just pay for my own, apparently unnecessary, pap smear.

    And I’m not even going to get started on the many insurance companies that have no problem shelling out for a horny old man’s Viagra scrip, but deny coverage for birth control pills.

  9. jaysonjaz says:

    I am a pharmacist and I often get caught up in United Healthcare’s crap. I think that they are hands down THE WORST insurance company that I have to deal with.

    I had a guy come in a few weeks ago and they would not pay for hemorrhoid suppositories for a poor guy. I called the doctor to get him to switch it to a hemorrhoid cream (which was about half the price) and they would not pay for that either. The doctor then called United to get them to cover either the cream or the suppositories. After the doctor called and explained the obvious necessity, they still refused to pay for either. What a pain in the ass.. literally.

    Homerjay is right though. Most of these companies have their own fair share of nonsense. United just happens to be the worst of them all.

  10. weave says:

    I have Medco. My employer recently switched to them promising they covered the same drugs at the same cost as our previous company. I looked at the fine print and it has a list of drugs that they say they can limit to certain quantities a month. My main drug of choice, Imitrex, is on that list. If I go over this secret number, they too say it will require a review between them and my doctor.

    Imitrex is a life-saver for me, but it costs $20 a pill. If I don’t pop a pill in early stages of a migraine, I’m in for 24 hours of horrible pain where I can’t even function enough to stand up. Not even a shot of Demerol will save me at that point.

    So far I haven’t hit this secret amount. I’m going to be in deep trouble if I do. I’ll find myself wondering whether or not to take each pill and if I make a wrong choice, I’ll be in bad shape for a day. :(

  11. ChazB says:

    This is becoming a problem here in Canada too. I have Blue Cross through work. I was given a Rx for an Asthma inhaler by my doctor because I’d had a really nasty chest infection, and my doctor said it would help me breathe.

    I’m glad I don’t have Asthma or any other condition requiring an inhaler on a regular basis. My pharmasist told me that Blue Cross will only cover the first Rx for inhalers. Then, if you need a refill, you have to apply to see if they’ll fill it. She also told me that unless you need it to survive, they’ll deny you the refill forcing you to pay over $100 per refill.

  12. annms says:

    This is America. Let me give you a hint… Tort reform is a bad idea. You know why? Because then you can’t SUE!!!

    Let me see… failing to cover a doctor written prescription, a bad result, and a jury. I am sure not covering 15 pills is really going to sit good with a jury…

  13. bones says:

    These lying insurance companies promise their “clients” the moon and deliver feces. The lies they tell patients easily qualifies as the 21st century equivalent of carney schuckterism. They tell these poor people they’ll pay for their medical needs then deny the charges, they lie and tell them a call from your doctor will get them their meds – those “calls” take 2 hours with the phone tree from hell and then the doctor gets an automated fax denying the need for the medicine. I’ve seen medicines disapproved for “equivalents”, even though the request stated clearly the patient was allergic to the medicine UHC recommended. Upon calling the allergy to the attention of the reviewer at UHC, a second fax was received recommending the medicine the patient was allergic to again. I’ve seen the company deny necessary medicines and blame the doctor for “failing to request” the medicine from UHC, fortunately the doctor had all the faxes and phone calls to th company well documented.

  14. froggie says:

    I recently had the same problem with a prescription for my son. The prescription was for 1 1/2 pill a day of a 50mg dose (75mg total). The insurance refused to cover the 1/2 pill portion. The solution (at my pharmacist’s suggestion) was to have the doctor write a separate prescription for 25mg of the drug. Yes, the insurance company honored (and continue to honor) both prescriptions.
    Do I understand this? No. Am I going to argue with them about it? Not while they continue to pay.

  15. Martin says:

    All of the stories above my post happened because back in the Reagan era, the U.S. passed a federal law called ERISA. Basically, ERISA says that the only thing you can sue an employee benefit plan (be it insurance, 401(k), etc) for is the amount of money that they owe you.

    No punitive damages are available under ERISA. Thus, while you can sue your car insurance company for punitive damages if they don’t fix your car, you cannot sue your health insurance company for punitive damages if they refuse to pay for necessary health care or meds. This applies even if you die because they refused to pay.

    Since the insurance companies have no risk, other than the risk that they might actually have to pay your claim later, they have no incentive to pay your claims now.

    If you want the law changed, vote Democrat and call your Senator/Congressman to complain.

  16. Fuzzyman says:

    We’ve had similar problems with Medco, though they’ve never stopped paying for a prescription once they started. If there’s a problem we pretty much find out the first time the scrip is filled, and a letter faxed from the doctor’s office to Medco fixes the issue (we know the system pretty well at this point).

    I do have a problem with the formulary of approved drugs and their approach to it, as it really second-guesses the doctor’s judgement. For example, for stomach issues I had been on Prevacid. When I changed jobs and got Medco, Prevacid wasn’t on their forumulary but Nexium was. That was okay, they were equivalent proton pump inhibitors. But they would not approve a scrip for Nexium until I tried a less expensive acid reducer (Zantac) first. I had tried that before under my previous plan, but since they had no record of it under their plan, no go. My doctor ended up writing a scrip for Zantac, giving me enough samples of Nexium to tide me over, then gave me a Nexium scrip a month later (which I then had no problem filling). Silly.

    A new thing this year was actual copay penalities if you have an ongoing scrip that you don’t fill through their mailorder system. So, the first three months your copay may be 20%, but if you continue to go month to month your copay goes up.

    Percentage-based copays are another way they are trying to steer our decsions on prescriptions. No more flat $20 or even $30 copays for us (remember the days of $15 copays?). Now a scrip can run us $70 or $80 a month if it’s a newer drug with no generic.

  17. aka Cat says:

    Smashville, what’s the difference between Wellbutrin and Wellbutrin XL? I ask because there is a generic for plain Wellbutrin.

    Drugs are frequently used for more than one purpose, and insurance companies won’t pay for some of those uses. That’s why they want to talk to the Dr — the prescription doesn’t specify why the drug is being prescribed.

    For instance, Retin-A is used for acne, but it’s also used to reduce wrinkles. Acne is (usually? sometimes?) considered an eligible medical problem, while wrinkles are purely cosmetic.

    Similarly, Wellbutrin is used as an anti-depressant and also to help people stop smoking. The latter use is strictly short-term, so if you’ve been on it for a while they’ll want to make sure that’s not what they’re paying for.

  18. Smashville says:

    One major difference is that XL is only one dose per day…I honestly don’t know…maybe my doctor had a deal with the company.

    I do know that one part I don’t miss about it is that Wellbutrin XL gave me the worst shits of my life…I felt like a panda bear…sitting there talking to folks and then…oh…there I go…

  19. humphrmi says:

    My employer switched to United this year, from Cigna. I’ve payed 20% higher premiums this year, and United has weasled out of paying most of my claims except the most clear-cut ones. I have nothing but bad things to say about United Health Care. Next year I’m changing jobs to an employer with Cigna, and I can’t wait.

  20. Fuzzyman says:

    I wonder if Cinga prescription coverage is relatively good, because I have Cigna for my general medical coverage but my company went with Medco instead. How do they compare? Not that I have a choice, mind you. It’s Medco or nothing.

  21. A new thing this year was actual copay penalities if you have an ongoing scrip that you don’t fill through their mailorder system. So, the first three months your copay may be 20%, but if you continue to go month to month your copay goes up.

    I went through that a few years ago when I was still covered by my father’s insurance. They messed up my first order by filling it for the wrong dosage and insisted that the doctor wrote it that way on the perscription.

  22. UASteph says:

    Smashville – The XL messed with my stomach too, and was actually the reason I switched back to the SR. I’ve had very good luck with the SR formula. I have to take it twice a day, but depending on your dose, you still may only need to take it once. It’s definitely worth revisiting with your doc if you feel like the meds would be helpful.

  23. Ass_Cobra says:

    I make this argument day after day to people that believe it is axiomatic that the private sector can provide any service better than the public sector. Privatized healthcare is a bad idea. It is not a consumer good. The end user does not have a real choice in allocating its purchasing power, some dork in HR does that for you.

    A national provision of some base level of healthcare would prevent (or lessen) the instances of large companies (I’m looking at you Wal-Mart) massaging people’s hours to avoid offering them benefits. It would also enhance labor mobility as employees wouldn’t have to worry about losing coverage when switching jobs. Health insurance companies have zero incentive to actually perform for the end user, they just have to keep the benefits buyers at companies happy. This is easy to do, a slinky with a BC/BS logo might do the trick.

    End of the day, with some base national coverage, the higher end private supplementals would have to compete on actual service. Right now there’s a fixed pot of consumers who pretty much have the binary choice of A) being uninsured or B) being insured. There’s not really a way to increase market share through services, it’s just a matter of controling costs. For those playing at home, controling costs is a euphamism for denying coverage.

    The US spends 15% of GDP on healthcare, other developed nations generally spend 7-11% of GDP on healthcare. By every objective measure (infant mortality, life expectancy, etc.) the US is below average compared to other highly developed countries. It’s a disgrace and it should change, but it won’t because healthcare is a business not a right. Ask Bill Frist.

  24. “She also told me that unless you need it to survive, they’ll deny you the refill forcing you to pay over $100 per refill.”

    Geez, what kind of asthma inhaler is that?

    We currently have fairly decent insurance (knock on wood) that just costs an arm and a leg. We pay substantially more than we ever get out in benefits, but being uninsured is a bad option.

    My sister, however, had the insurance company try to deny her lifesaving medicine after she was on the insurance for 16 years with no problems; the minute she ACTUALLY GOT SICK they told her she was too expensive to cover and tried to drop her and/or deny care.

    Our last insurance plan was actually excellent – inexpensive and anything in-network was covered, no questions asked – except for their pregnancy policy, which was uproariously funny and moronic. In order to have the pregnancy covered (all prenatal and birth costs), they demanded you inform them BEFORE you get pregnant that you are attempting to get pregnant so they can pre-approve the pregnancy insurance costs. However, such pre-approval was only good for 30 days. So apparently as soon as you started trying to get pregnant, you were meant to call them every month and say “still trying!”

    I know they were trying to deny lots and lots of pregnancy coverage on the technicality of “oh, hey, you didn’t tell us BEFORE you got pregnant so we don’t have to cover it!” I’m sure 90% of people just lied to them, though. Personally I’d have waited until the EPT test said I was knocked up, then call and say “I’m going to try to get pregnant!” and then call two days later and say “I’m pregnant!”

  25. Mary Marsala with Fries says:

    I’m with Roddy; these companies should be illegal. They’re inefficient and they don’t do what it should be their core mandate to do — help people get and stay healthy. They’re almost completely concerned with their bottom line (which is not the same thing as being smart about money — it means that they see a 1% gain in money as worth giving up any amount of service, as long as they can’t “get caught” for it) and the government has done a dismal job of forcing them to fulfill their purpose (outside of making rich executives). The fact that they inflate prescription drug prices so unbelievably much (to the tune of hundreds of thousands percent profit), and are allowed to claim that it’s to cover R&D without ever providing the numbers to prove it is disgusting. We all know that money’s going to fancy marketing and bribing doctors, and they’re allowed to get away with that and so much more. I’m utterly disgusted in our society for blatantly valuing money-for-the-rich over basic health for everyone.

    The last straw for me was the Oct. 2005 bankruptcy rules changes, which made it impossible to discharge medical debts by declaring bankruptcy. So now that I’m one of the millions of uninsured, working in Michigan which has the highest rate of people *with jobs* who aren’t offered insurance (and a Republican gubernatorial candidate whose answer to lack of insurance was “get a job”), if something happens and I get stuck with a huge bill, I can just pay it off forever. There’s “western civilization” for ya.

    -PD

  26. acambras says:

    Eyebrows McGee — that’s insane about the pregnancy policy — *lots* of women get pregnant without trying. I also think these companies that have refused to pay for birth control are really short-sighted — it costs a lot more to pay for prenatal care, childbirth, and health care for a new child. Fortunately, some states are now mandating b.c. coverage. My BC/BS policy covers b.c. pills — they certainly should if they’re going to cover boner pills. And doesn’t it make sense to cover smoking cessation and other substance abuse issues, rather than pay for treatment of lung cancer, cirrhosis, etc. down the road?

    It also gets me how companies discriminate against people with mental illnesses — if the criterion is “does the patient need the drug to survive?”, they could rule out quite a few psychotropic drugs (God help us if the Scientologists get control of the health insurance industry!). While someone might not drop dead if they don’t get their Paxil or Lexapro, it can have a tremendous impact on quality of life. And if you want to quantify the impact in terms of business, there are plenty of numbers available about how depression costs so much in lost productivity, sick days, etc. And it’s hard enough battling the nickel-and-diming insurance companies — try doing it when in the throes of a major depression.

  27. UASteph says:

    acambras — Exactly. And who decides what drugs are “necessary for survival”? One could theoretically make the argument that psychotropic drugs *are* life-saving for people with certain mental illnesses, if only that they’re now much less likely to attempt to drive their cars off a bridge. With the stigma placed on mental illness in this country, its hard enough for people to get up the nerve to ask for help. Denying coverage as medically unnecessary just reinforces the mistaken concept that they aren’t real problems at all.

  28. aka Cat says:

    Smashville, it sounds like the XL is just a double-dose of Wellbutrin SR — which *just* went generic about a year ago. My Dr said a while ago that I could take the whole dose at once, so now I’m just paying the generic copay.

    Though he also said that less than half his patients moved to the generic with no problem, so your mileage may vary.

    I wonder why health insurance can’t be a co-op, like credit unions are. It seems that would work a lot better.

  29. Triteon says:

    If you want the law changed, vote Democrat and call your Senator/Congressman to complain.
    This is not– as so many other issues raised on this fine are 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?

  30. formergr says:

    acambras- My state mandated birth control pill coverage several years back, and my insurance company co-pay promptly jumped from $10 to $25 relatively shortly thereafter. I’m pretty sure it’s no coincidence that the average price for birth control pills without insurance is right about $25… So I went from being excited and saving money for two months, to being right back where I started…

  31. acambras says:

    formergr — I’ve said it a million times — insurance companies are EVIL. It sucks but it doesn’t shock. I don’t know what state you live in or what insurance you deal with, but some are less sucky than others, I guess. :-(

  32. hokiexterra says:

    The thing is, health insurance companies don’t necessarily WANT to pay for smoking cessation and other preventative measures because they (or someone else in the backslapping industry) PROFITS off the treatments given when the disease/pregnancy/crisis reaches a critical point. It’s an inherent conflict of interest.

  33. media-matt says:

    Unfortunately this problem is not as simple as sucky insurance companies. As RowdyRoddyPiper said, healthcare consumes 15% of our GDP and is over a trillion-dollar industry in the US alone. A lot of the cost increases are actually being driven by the government cutting Medicare payments, shifting the cost to those of us insured by private carriers. And now they are planning to cut payments again! Soon doctors will stop taking Medicare patients all together.

    Statistics also show that as much as 80% (give or take) of our medical expenses are driven by lifestyle choices (smoking, fast food, obesity, etc). So take a look in the mirror before you blame everyone else.

    A third issue is that many, many, many of these types of problems are driven by an industry that is afraid to embrace technology and create more efficient ways to work. Such as creating medical databases that allow access to patient histories on demand (no more fed ex-ing records, etc.). Coding errors and overly complex administration systems both raise costs and make efficient care impossible on all sides.

    The cost of new technology is also driving the need to recover R&D costs. For example, it can cost $500M to $1B to bring a new drug to market. Anyone ready to give up their Zithromax for old school penicillin?

    As someone working in the insurance industry (but not for one of the big companies), United Health Care does have some customer service issues that need to be fixed. However, all insurance companies are just trying to run a business, they don’t set out to screw consumers – but that just seems to happen. So make use of your insurance agent, a good one can be your advocate and cut through some of the crap.

    The rising cost of healthcare has too many players (consumers, the gov’t, insurance, hospitals & doctors, Rx companies, etc) to have an easy fix. The healthcare industry must embrace a consumer-oriented system – including transparency and a simplified pricing system- before it collapses in on itself. If it does not change, the government will take over. To get a sample of that just think about dealing with the BMV, the IRS, and the Post Office all wrapped up in one institution deciding who gets treatment and who does not.

    For those of you who like a good academic debate, economist Michael Porter has a great article entitled “Redefining Competition in Health Care” from Harvard Business School Publishing.

  34. juri squared says:

    I’ve said it here before and I’ll say it again – health insurance companies are the worst plague on America today, for all the reasons above and more.

    And to add on the bandwagon, I’ve had the exact problem the submitter has, twice. It’s nothing new, and it’s so rampant it’s disgusting.

    Then again, my insurance company (Aetna) hates me. As an asthmatic bipolar pregnant woman, I cost too damned much to be treated like a valued customer. My monthly out-of-pocket medical expense is usually in the range of $200, not including premiums. And I consider myself lucky that it’s so “low.”

  35. Kangarara says:

    If the Wellbutrin is anything like Effexor, your XL will be equivalent to my XR (extended release). Basically, because of the length of time it takes a drug company to get a drug approved for market (often 10-15 years), they only have a relatively short amount of time while it’s still on patent & protected from generics.

    So what they do is then patent variations of the drug that are under patent for the full 25 years and market those. Effexor has a generic equiv, but Effoxor XR doesn’t. In my case, my doctor has seen bad experiences with the generic form, so he writes the XR prescription so that I (and others) get the branded version. The provincial government (and most extended health plans) will cover a branded version if there’s no generic.

    Your doctor may be doing the same thing.

  36. acambras says:

    Media-Matt, it sounds like you’ve been reading (or writing) too much health insurance industry propaganda lately.

  37. Antediluvian says:

    Weave — re: Imitrex:
    Our ins co only covers 8 pills / month, regardless of the size of the pill. Our doc prescribed the larger pills and we cut them in half. Instantly twice as many doses.

    Refills can be gotten a little over ever 3 weeks. Use them and refill often enough so you have enough pills to keep yourself properly supplied.

    If you need a pill but have run out of refills, your pharmacist may be able to “front” you one or two doses while you’re waiting for the doc to refill or for the next monthly refill cycle to roll around. Our local CVS sometimes does this for us. It’s also good to use a national chain when travelling in case you need something refilled while on the road.

  38. “Statistics also show that as much as 80% (give or take) of our medical expenses are driven by lifestyle choices (smoking, fast food, obesity, etc). So take a look in the mirror before you blame everyone else.”

    That’s fine and dandy, and I’d actually save a LOT OF MONEY by paying for my own health care rather than paying for insurance. I take two monthly Rxs, see the doctor for a physical yearly and probably two or three times when I get acute sinusitis. I’m not the cheapest patient, but I pay WAY MORE for insurance than my non-insurance health care costs are.

    So why am I not dropping my insurance? Because if I got in a car accident, or needed to be hospitalized for a serious illness, or had a heart attack, I could never afford to be uninsured. It would ruin my life, and my family’s. (Also, pregnancy and birth is totally unaffordable without insurance, but that’s a slightly different problem.)

    Why isn’t my health insurance more like my car insurance? Why don’t I pay for routine maintenance myself, and then pay much LESS to have coverage for the catastrophic events? (Heck, divert 1/10 of the resources freed up by not having to screw with copayments on yearly physicals and you could track the data and give people a discount for GETTING yearly physicals and taking reccommended meds!)

  39. Ass_Cobra says:

    “Statistics also show that as much as 80% (give or take) of our medical expenses are driven by lifestyle choices (smoking, fast food, obesity, etc). So take a look in the mirror before you blame everyone else.”

    This is a good point. The fact that health insurance is gene

  40. Ass_Cobra says:

    “Statistics also show that as much as 80% (give or take) of our medical expenses are driven by lifestyle choices (smoking, fast food, obesity, etc). So take a look in the mirror before you blame everyone else.”

    This is a good point, and the fact that group health insurance is generally not permitted to be risk priced tends to put the burden of paying for poor lifestyle choices onto those that do not engage in such activity. It’s generally thought to be okay to charge someone more because they are a poor driver, but a taboo to do so because they have a two whopper lunch. Maybe the only way to solve this is to allow health insurance companies to risk price insurance.

    Another commenter had pointed out that the only reason they carry insurance is that the downside on catastrophic illness/injury is way too much. This is a case of making sure that you can withstand the odds beating you before you try and beat the odds and it is totally apropriate behaviour. This is precisely the reason that a federally funded backstop could really improve consumption patterns in offered healthcare. If someone knows that they are on the hook up to the first $50,000 but they can live with that, it could encourage people to really weigh the costs of going to see a doctor about every little thing. As it sits right now, only the aggrivation of doing the paperwork or the risk of something not being covered is able to deter me from seeing the doctor anytime anything is wrong (well that and the whole missing work thing), but this hardly seems like the right way to encourage responsible consumption of healthcare resources.

  41. acambras says:

    But Roddy, are you saying that wellness-type appointments aren’t responsible consumption of healthcare resources? Because if you talk about setting a $50K deductible (which is basically what you seem to suggest in your post above), many people aren’t going to get preventative care.

    Doesn’t it make more sense for conditions like diabetes and hypertension to be diagnosed and managed early, rather than waiting for a stroke, heart attack, blindness or amputation down the road? Doesn’t it make sense for women to get annual gynecological exams to ensure early diagnosis of cervical, ovarian, and breast cancers (same with men getting exams for early diagnosis of prostate and testicular cancer?) Doesn’t it make sense for pregnant women to get proper prenatal care, to lessen the risk of premature birth and other complications that could negatively impact the child’s health for years?

    Like I said before, many health insurance companies are breathtakingly short-sighted when it comes to supporting wellness programs. If we focused a little more on the prevention (or at least early diagnosis) of illness, we could actually lower the number and duration of doctor and hospital visits, thereby aiding in the “responsible consumption of healthcare resources.”

  42. magic8ball says:

    I asked my doctor why the health insurance companies are so short-sighted as to refuse to cover my birth control prescription. Don’t they realize that it costs them a lot more to pay for me to have a baby than it would for them to just shell out for the pill? The doctor pointed out that the insurance company is betting that b.c. is so important to me that I will find the money to pay for it myself rather than risk getting pregnant when I don’t want to. And guess what? They’re right. I think this is emblematic of their philosophy on a lot of non-life-saving and preventive-type stuff: they are betting that that medication or annual physical or whatever is important enough to you that you will find a way to pay for it yourself.

  43. kreationhidden says:

    Roddy and MediaMatt – I disagree strongly with your statement. While there are indeed cases of people going to a doctor because they got a scrape, there are a lot of cases involving people who had serious problems but don’t get it checked out because they can’t afford an extra 100 – 200 dollars for a doctor’s visit. That’s a pretty hefty chunk of change for people my age, especially ones who don’t want to get into credit card debt for things they can “live with”. Lifestyle choices do indeed affect people’s health, But how many doctor’s have lamented “if they’d only come in sooner we could have treated this so much quicker and cheaper”?


    My Situation: I am a 23 year old male, I don’t smoke, I don’t drink, I don’t do drugs. I live a pretty mild life by most standards. My girlfriend and I live together in an apartment in VA. I am soon to be paying 200ish a month for coverage on both myself and my girlfriend through my employer with United Health Care.

    With that coverage, I intend to take my girlfriend and I in to meet a mew primary care physician who works in that network, get a prescription for my asthma as it has started getting worse again (I was on ventolin/albuterol in the past, but it went away for a few years and has returned) I would like to meet with an allergist to see if I can find a set of pills like Allegra and Singulair which would allow me to sleep through the night. At current I wake up twice a night regurally unable to breathe and need to take what’s left of my old prescription for Albuterol.

    The costs of doing the above tasks for me out of pocket far exceed what I can reasonably spend while still having money to pay for school / bills. Health Insurance from my perspective is here to cover exactly this type of situation. Yes, it’s also great if I get into a car accident, But I need daily doses of medicines for things that are well beyond my control. My asthma has been with me since birth.

  44. media-matt says:

    Most insurance companies (well, at least the better ones) are beginning to recognize it is better to catch a potential problem early rather than wait for a huge problem to pop-up later. Wellness is now a huge buzzword for the insurance/benefits industry. Gotta love those buzzwords!
    They are now beginning to offer a lot more in the way of finding risks early. Things like diabetes, heart conditions, and even smoking can be dealt with a lot cheaper and in the early stages. Unfortunately it has taken many years and billions of dollars to recognize this.
    Just like all of us, it has taken a hit to the wallet to motivate both insurance carriers and employers to take action.

    Many of the new Health Savings Accounts and other Consumer Directed Health Plans are going away from PPO/HMO type programs. The individual is responsible for most of the smaller costs (dr visits, prescription drugs) until they meet a high dedcutible (anywhere from $2,000 to $10,000 for an individual, double that for a family)to get back to more of a catastrophic type of plan structure. The plan is then paired with some sort of savings plan (similar to a medical 401(k) or IRA) to help cover the deductible and coinsurance amounts. (Also many dr.s may give a discount if you pay cash so they can avoid billing headaches)
    This shifts the costs more fairly to those who use a lot of resources but still protects them in case of a crisis.

    FYI – many studies show the average American uses less the $500 in medical services in a year, and the old 80/20 rule (20% of the people use 80% of the resources) can swing to even more of a 90/10 situation.

    As far as reading/writing too much propaganda – sorry just finished my MBA and it included a couple of Health industry classes.
    In my opinion this is much like the Great Left Wing/Right Wing Media Conspiracies – if you really believe the Insurance & Health Care Industries are working together to screw the little guy you are giving them too much credit. They are two parts of a lumbering behemoth that rolls on out of control and to anyone who gets squashed, sorry it is not personal.

  45. acambras says:

    I don’t necessarily think the insurance and health care industries are working together — the insurance industry alone is evil enough to screw with people’s lives. Full disclosure — I have a very deep, personal contempt for the health insurance industry, based on my own experiences and the experiences of so many others. Somehow I can shake off troubles with retailers, utility companies, etc., but when the health insurance industry screws with me, I do take it very personally. It really gets me riled up.

    The other reason I don’t think the insurance and health care industries are in collusion is because almost every doctor I’ve ever talked to hates the insurance industry with a passion. Usually it seems to be over paperwork, getting nickeled and dimed at every turn, and having their education and judgement questioned by non-doctors.

  46. Maybe the only way to solve this is to allow health insurance companies to risk price insurance.

    Do we really expect health insurance companies to be able to do this properly? OK, you could assume that everyone at least 20 pounds overweight is eating junkfood and is therefore a risk but what about the skinny people who’s eating habits are just as bad? Are we going to have to get our arteries checked for buildup every year?

    What about adrenaline junkies? How are they supposed to know you make a habit out of putting yourself in harms way? What if you live in a bad neighborhood?

  47. acambras says:

    RP — I did actually have to fill out a BC/BS underwriting form about 10 years ago. It asked if I was involved in “high-risk sports” like hanggliding or skydiving.

    And I swear to you that it asked if there was any history of “female problems.” And they put “female problems” in quotes.

    Yes, I have a “female problem” — stupid-ass male bureaucrats who write stupid-ass underwriting forms. Much more painful than cramps.

  48. Ass_Cobra says:

    “But Roddy, are you saying that wellness-type appointments aren’t responsible consumption of healthcare resources?”

    Not at all. I think that preventative medicine is absolutely something that is overlooked by insurance companies. My point is in fact the opposite. If someone has a high deductible (that is basically going to cover them only if something really really bad happens) then they have an incentive to expend that ounce of prevention now, to avoid the pound of cure later. The fact that my insurance costs me the same regardless of my undertaking steps to prevent illness or not (through regular screenings, not smoking, not drinking to excess, etc.) is what distorts the price of healthcare in general.

    I’m not saying that people should only have high deductible insurance. What I am saying is that the high deductible backstop would allow people greater flexibility in chosing to insure every little thing, or not. I can imagine there are many families that would rather have the backstop in place and use the cash that they save to manage their own preventative care by paying for it out of pocket rather than insuring against everything under the sun. Some years they win, some years they lose, but they get the level of care (and can manage their healthcare costs on their own) rather than subsidizing a bunch of people that wash down their morning bag of chips with a 64oz mountain dew.

    “Maybe the only way to solve this is to allow health insurance companies to risk price insurance.

    Do we really expect health insurance companies to be able to do this properly? OK, you could assume that everyone at least 20 pounds overweight is eating junkfood and is therefore a risk but what about the skinny people who’s eating habits are just as bad? Are we going to have to get our arteries checked for buildup every year?”

    Oddly enough yes. Most other forms of insurance (home owner’s, auto, life) are priced individually based on empirical evidence. The insurer doesn’t have to catch every single one of your behaviours to price you apropriately, just enough of the ones that will determine if you are likely file a claim or not. The point of risk management in insurance is that having a large enough book of exposures will tend to have the outliers wash out and the portfolio should conform to some fairly straightforward statistical model. Not to say it conforms exactly, but it’s close enough that you don’t have to scalp people to insulate yourself against bad underwriting. Now arguably the human body consequently the things that can go wrong are much more complex than driving a car or insuring a house, but it might not be a bad idea to give it a shot.

    You do of course bring up the ethical questions (do I have to get my palque levels checked each year, adrenilin junkies getting priced more, etc.) that make health insurance a much more touchy subject than other forms of insurance, but if people want efficient allocation of healthcare dollars maybe some sacrifices have to be made.

  49. acambras says:

    When I was in grad school, I did have “major medical” insurance. The premium was about $500 a year and it was really meant to cover catastrophic injuries or illnesses — nothing else (e.g., no prescription coverage). I referred to it as “hit by a bus” insurance. I never had to use it — I wonder if it would have been worth the paper it was printed on if I’d needed it. But like other posters have said — it’s too risky to go without.

    It was interesting — the “card” they gave you was actually a piece of paper (like you might have for proof of insurance for your car), but I had to WRITE in my name, address, and social security number on the card myself. Yeah, that wouldn’t raise ANY eyebrows in the ER.

  50. MonsieurBon says:

    Acambras: “Major medical” insurance through B.C/B.S of Oregon really saved my bacon. I was a contractor a few years ago and paid about $54/month for coverage through B.C/B.S. There was a $10k deductible, but only a $2k deductible for “life-threatening emergencies.”

    I fractured my femur, which necessitated an ambulance ride and surgical implantation of a titanium rod in my femur. The bill was about $28k after insurer discount, and I only had to pay $2k. The hospital was happy to set up a $200/month payment plan for 10 months with no interest. Also, the follow-up visits were covered as they were related to the emergency.

  51. acambras says:

    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.”

  52. Ishmael says:

    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.

  53. ELiza522 says:

    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

  54. georgiaguy says:

    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!

  55. UHCVICTIM says:

    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.

  56. UHCVICTIM says:

    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.

  57. Peregrin says:

    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.

  58. Bumper-Bird says:

    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

  59. fhiggins says:

    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.

  60. SueCopening says:

    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.

  61. SueCopening says:

    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.

  62. SueCopening says:

    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.

  63. UHC_sucks says:

    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.

  64. LarsElectra says:

    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.

  65. paul-c says:

    @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!

  66. Anonymous says:

    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.