United Health Care Billing Nightmare

UPDATE: EECB Scores Direct Hit On United Health Care

Alexis writes:

Hello, Consumerist. I read your blog daily but hoped I would never have to write in. Unfortunately, that day has come. I am covered by United Healthcare under my employer. On April 23rd of 2007, I went to my OB-GYN for my annual checkup. I did not receive any additional tests, services, etc, just the basic yearly checkup. I paid my $10 co-pay, which is all that is required for routine annual checkups such as this, and I was out the door. About a month later, I received a bill from my OB-GYN stating that UHC did not cover the visit and that I owed them $90, because I had already paid $10 at my visit. UHC stated: “This Preventative Physical Examination Or Related Test Is Not Covered.” I called UHC and told them that all I had received was an annual check up. They apologized and said it was taken care of and that I did not owe any other money. Well, it is now February 21 2008, and I am still getting bills for $90 from OB-GYN Associates of Pittsburgh.

I have made an obscene amount of phone calls and wasted more time than I care to think about. After being told different various lies from UHC (i.e. “You weren’t covered at the time of the exam,” and “They are not in our network”), I finally thought I may have reached the bottom of this mystery. In early December, a supervisor at UHC told me that I needed to have the doctor’s office re-submit the claim under a different doctor with an individual in-network tax ID number, because they initially submitted it under the name of nurse practitioner who performed my exam, and she is not recognized nor covered under the UHC network. Easy enough – I called the doctor’s office and they complied. (Why did it take so long to get that answer? Why did they lie so many times in between?) The claim was processed on December 4th of 2007 under a doctor’s name who is covered and recognized under UHC, and an Explanation of Benefits was drafted showing I owe $0 from this visit. Finally, I thought this $90 had died.

I was wrong. Like a zombie, the $90 never dies. Just yesterday, February 20, 2008, I received yet another bill from OB-GYN associates of Pittsburgh asking for $90 in the mail. I thought I was going to hit the roof with anger. I called the doctor’s office this afternoon and asked what was going on. They told me that UHC refuses to pay them the additional $90 for the exam because, yet again, it “wasn’t covered.” I call UHC and get the same BS again regarding re-submitting the claim under an individual in-network doctor’s tax ID. When I told Jennifer, the representative, that they had already done this in December of 2007, her response was, “Well, obviously NOT.”

It’s obvious that UHC is just trying to save $90 by forcing me to get so frustrated that I just end up writing the doctor’s office a check. While $90 isn’t a lot to most people, (and really shouldn’t be a lot to UHC) it is to me, and it is also so incredibly unfair of UHC to be doing this, both to me and the doctor’s office. The bottom line is that they are NOT going to get that $90 from me, because I don’t owe them a cent more than my $10 copay.

This has been going on for almost a year. I’m at the end of my rope.

I ended up filing a formal complaint with UHC. If it is not resolved, I will take the issue to the PA Attorney General’s section on Healthcare. I would LOVE to do an EECB but I can find absolutely no e-mail addresses for any executives online anywhere. What is my next step?

By Googling searching *@uhc.com I found a find a number of uhc email addresses. (The asterix works as a wildcard when doing computer-based searches). UHC’s email address seems to format in three different ways, which I’ve ranked here from most prevalent to least:

firstname_firstinitialofmiddlename_lastname@uhc.com
firstname_lastname@uhc.com
firstletteroffirstnamelastname@uhc.com

I would suggest combining that with this list of executive officers…

Stephen J. Hemsley > President, Chief Executive Officer, Director
George L. Mikan III > Chief Financial Officer, Executive Vice President
David S. Wichmann > Executive Vice President; President of Commercial Markets Group
William A. Munsell > Executive Vice President, President – Enterprise Services Group
Thomas L. Strickland > Executive Vice President, Chief Legal Officer
Lori Komstadius Sweere > Executive Vice President – Human Capital
Anthony Welters > Executive Vice President , President – Public & Senior Markets Group
Eric S. Rangen > Senior Vice President, Chief Accounting Officer
Richard T. Burke > Non-Executive Chairman of the Board
Thomas H. Kean > Director

…And see if emailing your complaint to them gets you anywhere. Most of the addresses will bounce but perhaps a few will get through. If nothing happens, try a notch down the corporate ladder and find a list of regular VPs. You have a completely valid complaint, it just needs to be looked at by someone with half a brain to push your resolution through.

Comments

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  1. IndyJaws says:

    Mail fraud? Is it any different from any other company sending false billing when they have been informed many times otherwise?

  2. timsgm1418 says:

    I’ve heard, from someone that works in health care, that the companies routinely deny a percentage of claims because most people won’t fight it, especially if it’s a small amount. Pretty crappy customer service, but I’m sure it saves them a lot of money

  3. majortom1981 says:

    Why are you blaming united health care and not the doctors office. The doctors office screwed up not united. United health care probably paid them already and the doctors office still has it in their system that you owe them the 90 dollars.

    I know this is a bash big business site but i do feel its the doctors office billing you when they shouldnt be. They seem like they are palcing the blame on your insurance company when its not the insurance companies fault.

    • Mickey says:

      I work in a physicians office. Trying to call united helathcare is almost impossible. If we have to call Blue cross blue shield it takes less than 5 minutes to have it resolved. It is definitely the worst insurance in the world. Thier claims are processed in India and phillippines. They put us on hold for about 10-15min and they disconnect it on purpose. We have never had such issues with other insurance company

  4. TheHoff says:
  5. JustAGuy2 says:

    @majortom1981:

    I agree – the dr’s office is at least as likely to be the culprit here.

  6. K-Bo says:

    @majortom1981: I think if UHC had paid the doctor they would say so when she calls to see why they haven’t. Instead they say send more paperwork, so this probably is on UHC’s side.

  7. getem says:

    You are not alone in your battle with UHC- my company uses UHC for their health plan and it’s so ugly that a lot of us have opted to just not have coverage at all. They do indeed deny a percentage of claims to try to reduce costs, all the while you’re paying higher than industry average for premiums.

    UHC is a joke, it’s much easier to go in and say you aren’t insured, and then pay the reduced rate (we call it the alien rate) which comes out to be about 1/3 of the cost of the total bill everytime.

    Don’t tell UHC, but my company is planning on dropping them very soon. This should be a major blow to them- because we are the largest employer they provide health insurance for.

  8. rwakelan says:

    @majortom1981: UHC is admitting they are not paying the bill. Of course the problem is with UHC!

  9. kris in seattle says:

    Shit. I have UHC through my workplace and my copay here in Arkansas is $20. I haven’t had any problem with billing – yet.

  10. m.ravian says:

    “Human capital”. how depressing.

  11. hills says:

    I have been through this so many times myself I can do it in my sleep – You need to get a copy of your EOB that shows you owe $0 (you said they drafted one) – Then, fax that to your doctor’s office with a note reminding them that is ILLEGAL for them to counter-bill you for services for which your EOB says you owe $0. That dispute is between your doctor’s office and your insurance – they need to leave you out.

    Good luck!
    PS – good work not giving in and paying the $90 – just another nightmare to get that back!

  12. Dibbler says:

    I’ve had to deal with UHC many times on stuff like this. Usually it’s the doctors office that is the problem. They have to submit the procedure as a standard code that all insurance companies/doctors offices use. If the dr. office uses the wrong code the UHC computer spits it out and doesn’t pay. I call UHC and they tell me to contact the doctors office and have them re-submit the bill with the correct code. If the book keeper is an idiot like some I’ve dealt with they will just submit the same numbers again knowing that the numbers are wrong. Once it got so bad that the lady at UHC called the doctors office for me and called back later and told me that the book keeper is retarded (their words, not mine) and that they are at a lose as to what to do. I called the doctors office back a few more times and eventually they just sent me to collections. I’ve never gone back to that doctor…

  13. bohemian says:

    @lookatmissohio: UHC, I thought that stood for United Human Cattle?

    She need to get UHC to tell her it is paid or not paid and fax her printed proof of the status of this. If they say they paid the doctor already demand they fax her some hard copy proof. Something like an account ledger or an account record of the check or funds sent to the doctor.

    Either UHC is lying and they won’t be able to pony up proof of payment or the doctors office is lying and with proof of payment you can press them to stop trying to double dip between the insured and insurance company.

    If UHC admits they never paid it or can’t provide proof they paid the doctor then the issue is with them. Sic the state insurance board on them like hungry pit bulls.

  14. ptkdude says:

    What’s interesting here is with my new UHC coverage this year, preventative care is the ONLY thing they cover until I pay my deductible. Yet here they are refusing to pay for preventative care for someone else. You just have to love the creative policies health insurers come up with!

  15. bohemian says:

    @hillsrovey: How many people would pay the $90 because they are terminally busy or have no idea how to fight these things and think they have no choice. I would guess easily 30% would pay it.

    Getting some free money out of 30% of your patients or getting 30% of your insureds to pay their own bills in full is some pretty significant money.

  16. roytyo says:

    I had to go to the ER a couple of months ago because I had an allergic reaction and my throat swelled up and I was having trouble breathing. After a shot of benadryl and some antihistamines I gave the ER my insurance info and paid the $20 copay and 3 weeks later I get a bill for $900 from the Hospital saying that they never got the money. Luckily, I was registered with Aetna’s client website that lets you look at who has filed claims and if they’ve been paid, and sure enough the hospital had filed the claim and Aetna had paid them. (I had a PDF of the form with signatures and everything)
    This isn’t the first time I have been billed for services that insurance has already paid for, a year earlier my optometrist did the exact same thing. Sometimes it really is the Doctor’s fault.

  17. CuriousO says:

    I had the worst issue, I found out if you call your AG the calls and bills would stop. The AG is my state TX loves going after insurance companies.

  18. Elvisisdead says:

    There’s also the very real possibility that the doc’s office aren’t submitting the doc’s NPI and may be submitting UPIN. Especially if it’s a nurse practicioner that may not have an NPI.

  19. forrester says:

    I received a bill from sonora quest laboratories yesterday saying UHC had revisited my account and decided that $5.06 was not covered. Nice that UHC can take back money already paid almost a year later.

  20. phoenixsflame says:

    I used to work as a Customer Service Rep for United Healthcare, so here are some questions.

    When was your last routine check up? If it was within 12 calender months (To the day exactly, you can’t go a day early on some policies.) it will not be covered. Some have every six months, the same policy applies. You have to make sure, that your routine visits do not fall within your limit.

    Secondly, find out the Tax ID number from the doctor. You can’t ask about the Tax ID number over the phone, but if you provide them with one, they can say “Yea” or “Nay” if it matches.

    Find out if the doctor that they used is in UHC as a provider, they may be billed under a group Tax ID number, and individually not be covered. Find out if they have a group/practice Tax ID number or contract with UHC.

    Ask the CSR to read you the history notes, make sure that UHC has recieved BOTH claims, and ask them for the Dates the claims were processed.

    Once you have this, ask about the secondary claim (The one that came under the different doctors name. You can search by doctor name, date, and Tax ID number for claims.)

    Also, ask them to go into the Claim, and look up the Denial Code, there is a code right in there that if the CSR is smart enough can reference and say. “This was denied because of…”

    IF they tell you otherwise, they are lazy CSR’s and you should speak to their supervisor. Tell them you know a person who worked at the Chico, CA, UHC, and that you know what they can, and can’t do. Tell them to go into the back end if they have to.

    When I was working claims, I worked in the DOS screen and old system more, because you can navigate and find information faster than the ugly GUI they had everyone using.

    Seriously, ask these questions and you should have an answer. Chances are, the claims department tried to push through the original bill rather than the updated one.

  21. lakuma says:

    I say bring on Universal Health Care for everybody!! I’m paying $700.00 a MONTH just to cover my wife and daughter. I want what France/Canada/etc has!!! FREE health care for all. I rather pay more in taxes than what I am paying now each month!! Watch Sicko, you’ll see.

  22. phoenixsflame says:

    Sorry, I hate to post twice, but if anyone else has any questions I might be able to dreg up enough memory to help with UHC. I did claims for Blueshield, so I don’t know the CSR stuff. Sorry.

    (Edit on above comment : Make sure they’re using the right code, there is a five digit code they need to submit with their claim. If they submit the wrong code, it could be seen as something other than routine check up. MAKE SURE THAT IS RIGHT, a CSR or Claims Adjuster cannot, CANNOT change this, no matter what, it is against the law and the CSR could be fired for even saying they can do anything. If this is the reason for it, have them resubmit ANOTHER claim with an adjusted HCFA-1500 code. The HCFA-1500 is the claim form that almost all doctors use, and is used in the professional sector. UB-92′s are the hospital forms…)

  23. ezacharyk says:

    My wife and I are having similar problems with our insurance company and doctor.

    My insurace does not cover our geographic area, but because my contract works in the area and that is where I am employed, they have contracted with the regional hospitals and doctors affiliated with the hospitals.

    But when our family doctor bills us, they bill us based on the insurance company and not the contract. It is a pain in the butt, but the insurance company handles it.

    We like our doctor, it is just the billing office. After several calls to them, they straighten it out for that bill, but it happens later. We have told them several times to note the special circumstances, but it seems to be futile.

  24. timsgm1418 says:

    I wondered why they were buying all the forklifts and cattle prods@bohemian:

  25. DrGirlfriend says:

    Your doctor’s billing office is not fighting this battle enough for you. They should be. The way this sounds, at the first denial they are just billing you and not getting on the phone with UHC to duke this out with them. They have more knowledge about insurance billing and are better equipped to be fighting this denial. And I say this as someone who works with health insurance and a large hospital and has either fought these battles for a patient, or has seen others in her department do so.

    I agree about asking a CSR for a denial code for the claim each time you call them. This way you keep a more specific record of the reasons they are giving you.

  26. phoenixsflame says:

    @DrGirlfriend : I wish it worked that way, most of the time in all honesty the Doctors Offices let the patients out to dry. I had to fight for most of my members with my doctors office to get them to bill correctly, keep dates straight, hell I even had to bust a Dr’s chops for trying to charge a member OVER the comp’d amount.

    (Basically, if a doctor charges you 200 for a visit, and UHC only pays 120, thats 80 dollar difference is a write-off. I’ve had doctors try to bill patients for it, not understanding this. Very frustrating.)

    If it’s a small practice, the doctors and secretaries have no idea what they’re doing in all honestly. They pick up one of these professional programs, or professional packets that have all the codes in there and they just scroll through selections …. very poorly.

    I agree, large hospitals are WELL equipped, and when dealing with UB’s I had very few problems (Some line item deductions and silly stuff, but honestly the hospital bills I loved seeing because they were professional.)

  27. BrewMe says:

    I have UHC, get used to it. They manage to reject 60% of my family’s claims. After calling and having them resubmitted most (2 or 3 last year) get approved. The rest take an additional call. My wife’s claims get rejected the most. They even manage reject all her claims on one doctor that we both see, while my claims go through every time. Same policy, subscriber ID, etc.

  28. gingerCE says:

    Something similar over blood work done. I pay 80% of in network fees but they billed me for 100% of out of network because on the paperwork submitted I was told they had the incorrect gender code and even though I am female and have been female with this insurance company (not the one I’m with now) for years, they denied the charges because they claimed as a male I didn’t qualify for the bloodwork ordered. Had to have dr resubmit but it took me a while to figure out why they kept denying the claim (insurance company wouldn’t say–at first just saying they deemed the tests unnecessary). My bill was for $350 I believe–went to collections, out of collections, threatened to go back into collections, before finally it was settled and I owed under $35 (after in network discounts). Took about 9 months to get settled.

  29. gingerCE says:

    This was the same lab (quest) that did duplicate bloodwork on a previous visit–billed me twice, from the same blood sample taken the same day, and had different results on the same test — over a 10 point difference. Quest labs argued the dr. ordered the test twice (as if) but even if he had, why is the result so different on the same sample of blood? Eventually they agreed to charge me for only one test once I got the dr’s office involved.

  30. gingerCE says:

    Whoops I mean in earlier post, I pay 20%–80% discount.

  31. phoenixsflame says:

    @gingerCE : Yeah, you’d be amazed how awful Quest is. I’ve had run ins like that.

    A Good CSR will notice things, will look over the claim. You always look for Gender Codes on gender specific procedures. This is why knowing the ICD-9 Codes (The codes on the HCFA-1500′s) is so important…

    There are books in Barnes and Noble that a craft consumer can read, or maybe even a library where one can Xerox… If you are having trouble with your doctors office billing incorrect ICD-9 Codes, the best thing to do is find the one they use (I believe normal Dr’s visit is something like 99123) and research to make sure that the code they are using IS the code that they need to use….

  32. MissTic says:

    Agree with everyone about the Dr.’s office responsibility. Mine will go to bat for me with the insurance co. We’ve had a similar circumstance and they took care of it internally and told me after the fact. They wanted to get paid!

  33. Antediluvian says:

    @Freedomboy: What’s with the pottymouth?

  34. phoenixsflame says:

    @Antediluvian: It’s edgy, didn’t you get the memo?

  35. Antediluvian says:

    I had a similar situation last year w/ Blue Cross. Slight difference — the doctor billed me AND the “hospital” billed me: the doctor’s “office space.” Messed up beyond belief.

    Finally, after getting totally fed up, I said to Blue Cross: This is not MY problem, this is YOUR problem. _I_ am not going to call the billing party FOR you. You know the “magic words” to get them to fix this problem; I do not. I don’t know your lingo and I should not be expected to. Here is their phone number. Call them and get this done.

    Summary: put the two parties together on the phone. Conference them in if they won’t call for you. This should not be your fight — it should be their fight. Make them do the work.

  36. phoenixsflame says:

    @Antediluvian: Most CSR’s don’t have the ability to call out from the center. There is an escalation unit that can, and will do this. But, they are a small group among many incompetent people.

    You’re dead on, if you can conference or threeway with your biller, your healthcare, and yourself… It will go much smoother every time. It’s the best advice in these comments and I’m jealous I didn’t say it :D

  37. Crymson_77 says:

    I had a lot of fun dealing with UHC when they RETROACTIVELY cancelled my wife’s insurance when she switched providers….so getting them to REPROCESS all the claims is still haunting us…

  38. Benny Gesserit says:

    @Dibbler: Exactly what I was thinking. Is it possible she’s being billed because a Nurse Practitioner is down $90 in bill payments but the Doctor who they submitted the claim against is suspiciously showing a $90 credit?

  39. dorkins says:

    We have horrible problems with health insurance, but to believe Sicko – that health care in Cuba is great for everyone – is tantamount to believing the moon is made of Cheddar.

  40. Given2Fly says:

    I work in medical billing and see situations like this all the time. First of all, your physicians billing department is in the best position to help you. However, the fact that they are simply submitting statements to you without attempting to offer any help is unprofessional. I would not continue to see any doctor whose billing department abandoned you like this.

    Secondly, this appears to be the fault of UHC, not your physicians office. If your doctor is a participating provider, he/she probably has a long history of billing clean claims to UHC. Your claim should be no different. If they are questioning the Tax ID of your provider, it sounds like they are processing it as out-of-network. Sometimes all it takes is a phone call (which in your case didn’t work), and sometimes I have to appeal the claim with office notes so that it is bumped up to someone else in the appeals department. Regardless, your physician should not be shrugging their shoulders and forcing you to handle this. They have a contract with UHC and they need to ensure their claims are being processed according to their contract.

    In reality, your physician’s billing department should be your best weapon in having this claim processed correctly. Make them do it. Once this is over, find another physician to be your OB/GYN.

  41. hi says:

    @dorkins: mmm… chedder

    you do realize you’re the only person on this thread who mentioned sicko? you also realize this post wasn’t about cuba, but a zombie bill?

  42. phoenixsflame says:

    @hi: I think people are getting their panties in a tussle because of the picture on the post… But, you know, over-sensitivity is a national past time in the US.

  43. Jaysyn was banned for: http://consumerist.com/5032912/the-subprime-meltdown-will-be-nothing-compared-to-the-prime-meltdown#c7042646 says:

    @hi:

    Some people can’t see past their socio-political blinders.

  44. kc2idf says:

    I have found that a good solution for dealing with the insurance company when they are causing problems is this:

    1. Attempt to work it out with them directly. Use the mail, not the phone, because you don’t know for sure that the CSR took the right notes. Copy the doctor’s office on the missive so that they know you are trying to work this out (this can sometimes help stall any collections actions).

    2. If that fails, send another missive, but this time, also copy the HR department of your employer (assuming HR is the department responsible for employee benefits). Follow up a day later with a phone call to HR. If they start hammering on the insurer, the insurer is more likely to listen, because, unlike you, your employer has the option to go somewhere else.

  45. evilinkblot says:

    I’m in the insurance business, it really does sound like this is a billing issue that you need to be out of, this should be between UHC and your doctor’s billing dept.

  46. am84 says:

    This is the Alexis from the post. Thanks for all of your input, everyone. I will keep you posted, and hopefully this will be taken care of once and for all.

  47. Zelle999 says:

    If you are covered under a group policy, definitely contact HR. Your employer most likely has an agent and the agent has access to UHC individuals who handle escalated issues. Ask your HR department to call the agent or ask for the number directly.

    Besides, as kc2idf said, your employer can choose to change insurance carriers if they are not satisfied with the service they are receiving.

  48. Zelle999 says:

    @evilinkblot: Easy to say, but I’ve seen patients getting bills sent to collections as a result of this. The OP needs to be proactive and make sure that doesn’t happen by contacting their agenet/broker.

  49. Angryrider says:

    Wow! So many hurdles just for a freakin’ checkup!
    God bless American Healthcare!

  50. DrGirlfriend says:

    @phoenixsflame: I wish it worked that way too…because it’s how it is supposed to work. But unfortunately, billing departments at dr’s offices can vary from being an established, knowledgeable group of people in charge of billing for an entire practice, or it can be one random office manager who has other stuff to do.

  51. vdragonmpc says:

    I can say it all the time UHC cost my old employer an employee when they needed him most. I talked to the HR at my job about the denial of claims by UHC. They love to label claims ‘experimental procedures’ and deny them. When clinics require full payment up front from a member of an insurance plan something is wrong.

    I tried several routes and none worked it was FAR easier to just get another job. Hell with what I was paying in premiums and the doctors it was an instant raise heck even less salary was a raise.

    CSRs at UHC were useless I wore out a fax machine sending information to them including Aetna and Anthem documentation where they had paid the claims as needed. The executive departments walked the same BS line of experimental procudure for an 8 year treatment.

    I to this day want my premiums refunded as they never did anything for me and in the end couldnt even get me a ‘network discount’.

    To those that knock the Doctors office: the Doctor covered half the bill with us and billed us as uninsured which was basically the truth with UHC.

    V

  52. phoenixsflame says:

    @vdragonmpc: Very true, even as an ex-UHC employee I can tell you that 90% of the employees there are only interesteding 1 thing. Call Times.

    If they can get you off the phone in under 2 minutes? Their ACT goes down (Average Call Time), and that means that they don’t get a talking to by their supervisor. It also means, that they can be eligable for Overtime on the CRG (Customer Response Group), and that is GREAT, because there are no phones there. You send out forms, and you research claims and notes.

    The fact is, the 10% of us who knew what we were doing, were antagonized, attacked, and sometimes fired for going out of our way to help policy holders. There is a reason I got sick, and had to leave UHC. Stress…

    I spent roughly 20-30 hours on this one persons claim. His wife had died in labor with I think triplets? I won’t give his name out here, Mike M., and I worked my rear off. I researched claims, I printed things out, I obsessed over this guy. Because he was getting claims for his dead children, and dead wife… I couldn’t imagine something worse than this.

    So.. I fixed it. I worked harder than anyone around me, I got cussed out by a supervisor for staying on one call for over 2 hours with this guy. I had him three-way his hospital on the phone with me and we were going over things for a very long time…

    It took me roughly three weeks to fix all his claims, fix all the errors, and put notes in the system so the claims adjusters knew what was going on. I felt great.

    It took one month, for a claims adjuster to not pay attention, and send him another bill.

    Three months later, I get a call from his supervisor, I guess my name and my call center were listed in some of his notes. Mike M. was in the hospital, he had tried to kill himself. The burden of losing his wife, and his children was to much for him. His supervisor found that I was the one handling his case, and thought maybe I could pass the information on.

    I did, I left UHC from stress related illness two days later. I didn’t go back, and I’ve never told that story to anyone before. I think it is sadly appropriate here, because although the article is only about 90 dollars. These kinds of mistakes ruin peoples lives…

    I hate UHC for the wrong minded focus they put on their CSR’s… Having a hold time, or an ACT time ruins peoples ability to do their job. Having such pressure on the people adjusting and submitting/proofing the claims? Makes people do stupid mistakes that are sacrifices in the name of “efficiency” …

    Well, that was more than I expected to type so…

  53. trujunglist says:

    The same thing is happening to a co-worker of mine as I write this. He is constantly on the phone with UHC trying to work out a bill for a routine physical. It’s been months now it seems.

  54. iisanother says:

    United is indeed TERRIBLE about this sort of thing, but if you keep fighting, you’ll probably win. They do this all the time with me, I’ve had to dispute at least 1/3 of the claims I’ve had with them over the past two years, and additionally have indeed simply paid many that I knew I wasn’t responsible for when the amount was less than $20 — they obviously find that denying on the first try means more profit for them since many people will give in. Its a rotten trick, and I hate it when I do give up, but it does end up that the small amounts of cash aren’t worth the hours of customer service hell…
    it’s really a terribly broken system.

  55. zgori says:

    EVERY dispute to do with health insurance should be in WRITING. Particularly with United. There is no reason to ever call one of these call centers — they only thing they can do is complicate matters and introduce additional errors. Write clearly and without passion. Copy the doctor’s office so they know what the hold up is. If you’re comfortable with it, copy your employer’s benefits office as well (they’re the ones signing the checked to United). Read your plan document and refer to the relevant sections. Read the back of the EOB where it explains how to dispute and follow the directions. Everything should go through the mail. It’s slow, but when things eventually get resolved, they stick. Don’t worry about interest or penalties threatened by the doctor’s office — if it’s United’s error, those are ultimately their problem.

  56. landsnark says:

    I think that what is being lost in this thread is the fact that delays and automatic rejection of bills by insurance companies is a feature, not a bug. The longer and more often they delay payment, the longer they keep their money in the investment arm of their company earning dinero.

    For example, I don’t doubt gingerCE at all that insurance company’s computer reject paperwork when an improper gender code is used for gender-specific treatment. However, a person programmed the computers to reject these automatically instead of, say, flagging them for review by an employee. I can more or less guarantee you that the person that made this design decision was a businessman who damn well knew that when repeated thousands of times this would help the company’s bottom line.

    Put another way, do they automatically reject your insurance premiums when your check has the wrong address on it?

  57. zgori says:

    @landsnark:

    Not only that, but it helps them weed out their more expensive members, who get frustrated and become some other insurer’s problem during the next open enrollment.

  58. whatdoyoucare says:

    @phoenixsflame: Thank you for caring. You did the right thing by that man.
    I always try to instill upon my children that they will never regret choosing to do the right thing even if it is hard.

  59. whatdoyoucare says:

    @phoenixsflame: Thank you for taking care of that man. You did the right thing.
    I always try to instill upon my children that you will never regret doing the right thing even if it is hard.

  60. olivia2.0 says:

    I have just been through a health issue (I broke my ankle, and needed surgery), and I don’t see anything here that indicates that the actual visit was covered. Yes, they make the system complicated on purpose, but that doesn’t mean that you can just ignore it expect them to pay for whatever.

  61. pal003 says:

    I have experienced both sides of this – the frustrated patient and I have seen the Insurance company deny, deny, deny – sometimes on purpose, sometimes not. And it is not easy for the doctor (billing provider) either – sometimes resubmitted claims are denied over and over again. Be most concerned that the doctor office is not going to submit this to a collection agency – talk to them politely and explain your frustration with UHG. This sounds like a UHG billing error problem. Submit a complaint with the PA Dept of Insurance – Consumer complaint – you will get faster results than AG office. PA Dept. of Insurance is currently very interested in tracking complaints like this. Good Luck.

  62. cashmerewhore says:

    Preventative exam = annual checkup.

  63. landsnark says:

    @olivia2.0
    I just got over bronchitis, and I don’t see how the OP was asking them to pay for “whatever”. UHC even paid the claim at one point (before screwing the paperwork up again and effectively un-paying it). I’d say getting an insurance company to cough up any money is pretty strong evidence that the treatment is covered.

    There is a name for selling something to a consumer, then creating a maze of paperwork to delay or deny that something: fraud.

  64. ctpfla says:

    It was my case as well …was ordered basic routine exams (pap and Mammogram) and the company that covers us via my husbands employer said that mammograms were not covered for women under 40.

    Is it cheaper for Healthcare companies to pay later for bigger issues or to cover preventive medicine?

    If anyone has the information for the executives of BCBS of Florida, I’d be interested in writting them a letter. We have to stop getting bad coverage after paying for our policy premiums!

  65. phoenixsflame says:

    @cashmerewhore: Yep, and most of them are covered. There are some that aren’t, chances are this was covered and just billed stupidly. We’d have to actually have the womans policy infront of us, along with the bill to understand completely what happened.

    @landsnark: Just want to mention something to this comment. This could be true, but a lot of the times the system was programmed to reject because if UHC reviewed the amount of claims filed incorrectly by the professional sector, they’d have three times the amount of QA employees. This just isn’t economical, I’m not saying that they don’t reject for some pretty stupid reasons. (Sometimes, giving absolutely no clue as to why they reject, were I to program something like that, I’d at least make a system that gave a reason everytime… Some claims are just denied, and you have to go over the claim with a magnifying glass to figure it out.)

    @whatdoyoucare: Thanks, I feel the same why. My son is 4, and my daughter is 1… Hopefully I’ll be able to raise them with a feeling that if they are doing the right thing, and helping someone. Even if they go unrecognized, their touch isn’t forgotten. Unfortunately, this current paradigm seems to punish those who put their necks out for others… I hope when they’re a bit older, things will have shifted just enough so that they are rewarded more than I, or family has been in the past. :D

  66. chatterboxwriting says:

    @majortom1981: I could go either way on this one. I used to be an Employee Benefits Administrator for a company with about 125 employees and we had UHC coverage. I did have to step in on behalf of a few employees when claims needed to be resolved. Only one ended up like this – with UHC and the doctor’s office going back and forth. UHC said the doctor was not in-network; however, their web site clearly listed him as a network provider.

    I would also check with the doctor’s office, as majortom1981 suggested. I JUST received a bill for $900 from a hospital visit in 2002. I called my old insurance provider and they explained to me that they had sent the doctor’s office a letter stating that they needed to resubmit their claim to a different Blue Cross office (I am from PA but got sick in Miami, FL and was in the hospital there – so they submitted to a PA office, but were told to resubmit to the Miami office) but the doctor’s office never resubmitted the claim. So, 6 years later, I am the one being billed for services that were covered in full under my insurance plan.

  67. ShadowFalls says:

    UHC has horrible service and straight up bad practice.

    They had my specialist listed as one they cover, but the specialist hadn’t taken their insurance in a year.

    Not to mention the issues with prescriptions. They had Zyrtec on their formulary list as covered. But wen it went over the counter, the Generic of it was not even covered and they had my doctor change it to something else without asking which they didn’t even cover anyway.

  68. lorax572 says:

    @phoenixsflame:
    It’s not the ICD-9-CM codes that the insurance company is looking for. ICD-9′s are diagnosis codes. What you are referring to are CPT codes. An office visit of an established patient, for a “routine” OB-GYN visit should have been coded as 99213 with an ICD-9 of V72.31

    As for the mention of UPIN’s and NPI’s…
    ALL medical providers MUST have a NPI by 3/1/08 or the ins company WILL not CAN deny the claim.

    I work with ins co’s all the time…One company will still deny an initial claim for a mammogram for a male patient, you have to call and “remind” them.

  69. am84 says:

    @phoenixsflame: Thank your for all of your tips, and for all of your efforts to help that man with his claims. It’s nice to know there are still good people out there. Have you heard anything about whether or not he lived?

  70. goodkitty says:

    Wow this is amazing. So this is how insurance companies operate:

    1) Request members get regular checkups.
    2) Deny payment for said checkups, so members don’t do them.
    3) Drop coverage when members develop “pre-existing” conditions due to having not been checked regularly.
    4) Profit!

    Please (insert deity name here) make this insurance nightmare go away in January. Submit one bill to congress that says: “As of February 2009, all health insurance companies are illegal.” Done.

  71. phoenixsflame says:

    @lorax572: Thats right, sorry, it’s been a few years since I worked for them so the many, many, many acronyms are fuzzy… ::grins:: Thanks. I knew it had 99123 in it, just dyslexiaed the 2 and the 1.

    @am84: Unfortunately not, I left and that was that. I hoped he pulled through but, I don’t know.

  72. PurifyYourMind says:

    I went through the same thing with UHC. Got a bill for about the same amount as this woman too, $92. They claimed I was already covered under my university’s plan when I was not. I had to prove to them that I was not. By the end of it, I had the hospital sending *me* $25 because I’d overpayed in the past.

    P.S. Anyone else have a hard time typing in this comment box? It is really slow for me because of the feature of it showing you what you type as you type it in a comment above. Weird. Metafilter.com does it better.

  73. msjhmc says:

    United Health Group companies are infamous for cost-shifting to defenseless patients, especially those who do not have an advocate. Don’t take my word for it; go to the internet and search for all of the lawsuits and judgments against United, especially those brought by individual state’s Attorneys General, State Insurance Commissioners, etc. etc. United has been shown to be a rogue managed care company, especially when itcomes to their claims payment responsibility. Do you know anyone that was ever paid more than owed? ALWAYS unpaid or underpaid.

    Go to your doctor’s office and let them show you proof that UHC continues to refuse to pay the doctor the $90.00 and continues to tell them that you owe the doctor this amount. This is the likely scenario.

    If the fault is United’s, don’t waste your time e-mailing the criminals at United. File official complaints with the PA State Insurance Department, the PA Attorney General, the US Department of Labor (assuming that your employer’s plan is an ERISA plan), contact your Congressman’s office, etc.

  74. insure-no says:

    @majortom1981:

    What planet are you living on?

    Health insurance employees are paid to deny claims!

    Go to “BLOCKBUSTER” and rent – “SICKO”.

  75. eris says:

    I hear ya loud and clear on this issue. I have had pretty much the same nightmare with UHC but my on going battle has started since Sept. 2006. It’s taken over a year and a half and UHC still can’t get things straightened out. It’s the same story you have where first I was told that the doctor didn’t submit medical notes then the story was that I wasn’t covered during the time I went to see the doctor. It’s amazing though because they covered one of the doctor visits but not the others. I’ve called them repeatedly and I continue to go into the same cycle (no medical notes or not covered during that period of time). I honestly believe its UHC and not the doctor. I’ve asked UHC why in the world I suddendly wouldn’t be covered for those dates since I’ve been with the same employer for 4 years. Their excuse is that it was a computer error. I really don’t think they can continue making the same computer error for over a year and a half. The doctor’s office is now sending me to collections because of all this too. So its a complete nightmare having to deal them. I’m currently waiting for yet another reprocess on these claims and every week I call to make sure they’re working on it because a month can easily go by where the end the result is, “You weren’t covered during those dates of service.” The real question is, what can really be done? Who do we contact? How do we fix the situation?

  76. mydesertstudio says:

    I had the exact same situation with my insurance company here in AZ. It dragged on for months. I finally got in touch with the Arizona Department of Insurance. Find the Department of Insurance in your state and open a case file. They will assign you someone to handle your case and that person will take care of it for you.

    All of my bills were taken care of immediately once I did this. Also I wrote a letter to my State Legislator and sent a copy of it to my insurance company so they knew I meant business. My legislator was very interested because her focus is on womens’ health.

  77. uhcsucks says:

    question for getem – what company? I think my company is the biggest uhc customer. I will give a hint. my employee is a phone company and starts with a V. UHC is the most unethical company in the world. Anyone who was blaming a doctor or the doc’s office in the earlier posts obviously is either a united employee or at the very least, not a united customer. UHC has denied my baby coverage for the last 4 months even though everyone i speak to at uhc says I am covered – BUT no one can speak to the claims or preapproval department so i continue to receive automated rejections. It is a brilliant process that is working as designed. If anyone has an issue with a self-funded plan, contact erisa at the department of labor. the self funded plans like united’s are exempt from state laws but not from the feds.

  78. uhcsucks says:

    just to expand on the last few posts, mydesertstudio’s idea to contact the state legislator and state Department of Insurance is a good idea when the plan is not exempt from state law… BUT there are 2 types of plans. Premium Plans and self-funded plans. Premium plans work the way insurance plans should work where the emploer pays a premium fixed amount and then the insurance company handles the claims and payments. These are subject to state insurance laws. However, self-funded plans are exempt from state law and payments are instead handled by your employer. What this means is that your employer pays the claims at a variable cost when the claims are won by the employee! Talk about a conflict of interest. In these cases, contact the Department of Labor regarding ERISA (employee retirement and income security act) which governs these plans. Thanks

  79. aggiemom says:

    I’m a patient advocate and it makes me sick to keep hearing all these UHC horror stories. Most of my clients have UHC, so what does that tell you? It is very common for UHC to not “retrieve” documentation patients/doctors’ offices have sent in as responses to a UHC request–i.e., other health insurance, appeal info. Many times a CSR will “find it” sitting in some black pigeonhole, where it’s been for months, even. Then if they truly activate it, it takes another 30 business days to do anything with it. I wouldn’t have UHC if it were premium-free.

  80. worstnightmare says:

    I just got out from the hospital with brain surgery. I had kept both insurance’s. The reason is UHC denied coverage on Cholesterol-Lowering Drugs. Well just for having this still in force with mega life they canceled my coverage for something I did not know I even had. They also sent me a list of of reason’s for the canceled coverage.
    1 Another insurance still in effect
    2 taking shots for a knee spring. (not disclosed)
    3 had an ablation on my heart last year. This was done in 1994 not last year. They had asked anything in the last 10 years not fifteen. Well if I had canceled the insurance on my first company I would be in trouble as they paid to now 75% of the bills. I figure at least UHC would pay the balance, but no they won’t. All doc’s where turned over to my attorney to get to the bottom of this.

  81. rubbishandrubble says:

    On 12/31/08 I was admitted thru the Emergency Room and rushed to the Intensive Care Unit at Palm West Hospital in Florida where I was at the time, due to the very severe condition for which I am presently being treated. After a diagnosis of Acute Leukemia and three days in ICU I was released only to travel home to Knoxville, Tennessee where they have contacted my oncologist in order to immediately begin treatment.
    After an 800 miles drive, I was admitted at The Baptist Hospital of East Tennessee, with a 105 fever, seizures and atrocious headaches and bone pain.
    For the time being energy and time are commodities I do have -unfortunately – in a very limited amount.
    In my current health situation I simply do not have any other alternative facility I could use for the treatment of my Acute Myelogenous Leukemia, as this is a secondary cancer that was caused by the treatment of my Breast Cancer (five yeas ago), and now it is being treated by the same oncologist and his team (they are all In the Network). It just happens that The Baptist Hospital of East Tennessee is the only place where they work that can offer the type of treatment I need. It should have been obvious to anyone that my need of Urgent Care and continuity of a very complex and difficult course of treatment makes me eligible for Network Benefits.
    It is also ironic that on their website The Baptist Hospital of east Tennessee appears now as a In Network Provider.
    I have tried many times to resolve this and other claims wrongly processed, but the Claim Representatives have been less than helpful or even willing to understand all the aspects of this problem. Disappointingly, my appeal encountered the same attitude that refuses to address the problem and tries to justify indefensible decisions with unrelated and misleading statements.
    This is taking me, in my present condition a great deal of energy and time that I could use in addressing more important issues.

  82. VitoPartridge says:

    i am on the other end with a company that provided care to a patient and trying to get paid. Our claim is over one year old and all i get is the run around even from supervisors. i am sure that it is stall tactics in hopes that companies and patients will get so frustrated that they either pay themselves or write off. my blood pressure goes up every time i need to place another call. As an agency we will not accept any more patients that have united health as their carrier. We cannot work for free. No one (patients or health care providers) should not have this type of frustration. maybe more companies will take heed and drop united health and get an insurance company that will represent their employees as employers pay a great deal of money to provide this benefit to their employees. I have taken the suggestion to email the companies executives and will see if that helps.

  83. coloradogal says:

    I am experiencing the exact same thing. UHC told me it was taken care of about 3 months ago. I’ve now gone back and forth every 10 days for about the last month seeing if it’s been taken care of yet. I’ve requested that they call me to let me know either way, but somehow that keeps getting lost in the records.

    How it started with me was I called United Health Care and asked them of an Urgent Care Facility that was covered they gave me three in the Denver area. So I picked the closest one to my house. I went and paid my co-pay which was $30 for Urgent Care. I had to go back a week later, because the antibiotics weren’t doing the trick. No worries another $30 and I was good to go.

    Well UHC says that I owe another $15 for each of my visits, because it’s showing up as a specialist visit. Even though they told me to go to this facility and that they paid as it being an Urgent Care Facility for most of the reimbursements for my visits to the facility. They have even admitted that they billed wrong based on having the Dr.’s name on the bill even though it was under the facilities tax I.D.

    This is the most frustrating experience ever!

  84. sammy25 says:

    well i guess members need to know their benefit plan very well at times many services are not coverd and its specified in the benefit summary most of the time reps do give incorrect info so whoever is verifying the benefits should ask for a ref number and if the claim gets denied in future stating the service is not covered then you can always appeal the claim with appropriate documentation and along with the ref number and as far as preventive care is concerned its mostly excluded for oon providers..

  85. Haddy Nuff says:

    Watch out college students and parents! UHC’s latest scam is to take advantage and con you into believing you have coverage through the college and not have to worry about medical bills interfering with your education. They know how many families have lost family coverage lately. The fact is their coverage is so limited any actual illness will cost you so much in co pays you will have to leave school or cause the family to be so far in debt you will all be sick! They manipulate their wording of “coverage” and “limits” to meanings beyond your imagination. Anything not to pay. Their idea of “complaints department” is the fluky of the day and a circular file. They are the epitome of what is wrong with health care coverage today! Be aware, be VERY AWARE of this poor excuse of a health insurance company!

  86. babyxmom says:

    UHC has got to be the worst insurance company in the history of insurance companys. I have been a medical biller for years and I have never encountered as many problems with claims being processed incorrectly as I have with UHC. I also worked for a sister company of theirs and did any of you people know that they outsource to India?? The health care providers dont even know that their claims and patient information are even going to another country. People that have no idea what they are doing are processing these claims. I am actually on the phone with UHC right now for 45 minutes already, for the 8th time about the same issue. I work for a clinic and we didnt receive payment and the UHC insurance company is not paying us. Not because of a billing error but because, well the answer I keep getting is “I dont know why this calim was processed out of network it looks like your clinic has been in network for a long time.” I was givin an address to file a complaint and no phone number to follow up. So Im pretty sure that all that will do is waste my time. I cant beleive that UHC is still allowed to do the shit that they do. Idk I guess thats what happens when you have a bunch of overpaid cheifs and not enough health care experienced indians lol.

  87. Mickey says:

    united healthcare is the worst insurance company. We are not a participating provider. We have very few patient who have UHC. 99% of the time they apply everything towards patients responisibility. Trying to get a call through to UHC is almost impossible. It goes to other countries when providers call UHC. We have to go through mulitple steps and then finally it gets disconnected. We have trying for almost 4 hours to get through, but we are unable to reach UHC. This is the worst insurance. Truly all physicians should stop accepting UHC members. i wish there was someplace we could go to where they are held liable. I tried calling the insurance commissioner office and I was informed that only a consumer can complain about them. The only thing we as providers can do is not to accept their memebers