UnitedHealth Unapproves Surgery From 2 Years Ago, Wants $7700 Back

United Health Care, not content with merely denying life saving cancer procedures or refusing to pay for basic (covered!) checkups, took things to a new level by retroactively un-approving procedures they paid for in 2005. They sent reader Suzanne a letter and a bill for $7700, claiming the pay-out was an “administrative error”, and she needed to pay up. Check out the details, inside.

Hi there – I’m really hoping you and your readers can help me with my problem. I had two procedures done in December 2005 (laprascopy and a hysteroscopy). Prior to the procedure I called United Healthcare (my provider) and asked them if the amount the doctor was charging was considered reasonable. I didn’t want to have these procedures done by this particular doctor if insurance would not cover the cost (I had another ready to perform the procedure who was in-network). After being reassured by United Healthcare that the cost would be covered I decided to go with the out of network provider. A few weeks later I received almost the full amount for the procedure – they covered about 90%.

This week I received a letter from United Healthcare telling me that they made an administrative error and that they wanted me to send them a check or money order for 7700 dollars! This is almost three years later!!

I’m shocked and plan to appeal. Can they do this? I mean, it is almost three years later!?!?

I know UnitedHealthcare is really horrible when it comes to claims/billing but this is insane.

Thanks for any help you can provide.

Suzanne

Yeah, of course United Healthcare sees paying for your procedure as an “error”. We sent Suzanne to our list o’executve email addresses for United Healthcare, and hopefully she’ll be able to convince United Healthcare that this is just ridiculous. They approved her claim years ago, and they’re just going to have to deal with it. Unless, of course, Suzanne forgot to call “no takebacks”.

Comments

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  1. Buran says:

    It sounds like she got the in-network rate for an out of network doctor — BUT she’s right — they did already pay for it and should have to just suck it up and fix their system for the future.

    Sounds like someone’s claim-denial bonus got threatened.

  2. FilthyHarry says:

    Here is how they discovered the error:

    Accountant looking through files, sees an entry indicating a customer was paid.

  3. MsClear says:

    Tell me again about how great the American health care system is? Tell me about how we’d all be so much worse off under a universal system?

    Oh wait……

  4. MsClear says:

    Tell again about how we’d all be so much more badly off under a universal system?

  5. timmus says:

    Nice idea! I run a home business, and goshdarnit, I meant to charge $35 instead of $25 for one of my book titles last year. I’ll go ahead and retroactively bill all my customers.

    Wow, what a way of doing business.

  6. Black Bellamy says:

    She should tell them “After researching the matter I must deny your request. My policy is to be notified of any billing disputes within 180 days, and since that term has passed there is nothing I can do. Also, please note I am enclosing a bill for $75.00, which is the standard fee for researching the matter.”

  7. More proof of the shitty Healthcare system in America…

  8. Now that I think of it, a system equivalent to NHS in America sounds damn good. Extra taxes to make sure I can get a damn good doctor (and for those who understand the reference: a ride home rather than getting dropped off in Central City East on Alameda and Third).

  9. Osi says:

    Retain a lawyer. This was almost three years ago, and they already paid. What they are trying to do now is extortion.

  10. sir_eccles says:

    “money order”? Hmm that gives me an idea, see I have this money in Nigeria I can send by Western Union wire transfer. It’s for a little more than you need so you can just pay off the bill and then write me a check for the excess…

  11. azntg says:

    UnitedHealth: “Put your sticky hands up! This is a f*ck up! Oh damn! Wait a minute…”

  12. bones says:

    Meanwhile the CEO of United Health Care makes an 8 figure salary plus bonuses and you who had insurance and cleared it thru the company need to be sucked dry so the CEO can continue to burn bundles of money in his fireplace. The saddest thing is that this is not uncommon and when people are so sick they are almost dying they have a badgering insurance company refusing payments, and making their illnesses worse because of the stress and worry they create. Let’s elect a democrat to help disassemble these “health” rip off companies so they can face unemployment without insurance like so many of everyday Americans have to….

  13. Shadowman615 says:

    Just send back a short letter telling them their request (or, even better, “claim”) has been denied.

  14. DrGirlfriend says:

    Enough with the knee-jerk universal health care sanctimoniousness already. Especially since if you are trying to criticize private insurance, what you want to be sanctimonious about is “single-payor”, not “universal”. They aren’t the same thing.

    I love how insurance companies have a timely filing limit (providers have a certain amount of time to submit claims) and rarely do they exceed 15 months. But retroactively denying your claim? Why, there’s no statute of limitations on that!

  15. Verklemptomaniac says:

    It might be worthwhile, if UH is unreasonable, for her to pay a few hundred to a lawyer to fire off a nastygram with the words ‘detrimental reliance’ in them. She relied on the fact that UH said the procedure would be covered in choosing the out-of-network doctor; had they said ‘no, sorry, we don’t cover that out-of-network’, she likely would have chosen an in-network doctor instead.

  16. juniper says:

    @Black Bellamy: I cannot think of a better response to this. Usually when people talk about sending these types of letters out, it’s to be funny. But here? The perfect response. Right on.

    She might want to itemize the $75:
    $25/hr research x 2 hours
    $20 paper and materials
    $5 bandaids due to papercuts

  17. am84 says:

    Wow, this is LOW. I’m not surprised, though. I REALLY hate UHC. I am the person featured in article regarding them denying a basic, covered, in-network checkup. Click on that artcile for their Executive Office phone number. That’s the only way I got my issue cleared up.

  18. Mr_Human says:

    @Black Bellamy: That was beautiful!

  19. am84 says:

    Nevermind, here is the UHC Executive Office phone number: 1-800-842-2656

  20. thesilentnight says:

    One anagram: SOL. She should look up the Statute of Limitations in her jurisdiction. Oh and United is also Shit Out of Luck. (weeping)

  21. smirky says:

    I had a much smaller but similar incident happen to me a few years back. I changed prescription insurance companies but my pharmacist billed my old carrier past the cut off date. For some reason they covered the script. About 6 months later I received a letter asking for the money back. When I went to the pharmacist to get help in refunding their dollars and billing the correct company, she told me to just ignore the letter. Once the company covered the claim that was it. They could not reverse their decision once the claim was paid. I ignored the letter and never heard another word about it.

    I don’t know if it’s a state law (TN) or what but hopefully something to the same effect applies in this case.

  22. Ex_EA_Slave says:

    What if UHC accidentally sent her a refund for payments of $7,700 and then requested the money be repaid 3 years later after the mistake was found? Would you still sympathize with her if she refused and had spent the money? It was ignorant to think any health provider would give in network coverage to an out of network doctor. This woman got something too good to be true and now she must pay for it.

  23. Trai_Dep says:

    Phew! Thank God she was insured! Otherwise, she wouldn’t be able to avail herself of the Best Healthcare In The Worldâ„¢.

    On a related note, several co-workers belong to a SHPS plan (prepay your allowable medical expenses taxfree). They discovered a clever little gotcha. Charge medical stuff on the handy debit card they supply. Call to double check they’re approved. Receive assurances the charges wouldn’t have cleared if they weren’t.

    Wait one year until many of last year’s charges are reversed saying further documentation is needed. Of course by then, receipts are lost, thrown out, forgotten. Aetna is apparently unable to retrieve the info entered at time of purchase or approval, leaving it to you to work it out. A Sysiphean task abandoned by most.

    I’m not sure if it’s evil or incompetent. But it sure is sleazy.

  24. smirky says:

    @Ex_EA_Slave:
    If her letter is to be believed, she verified coverage before having the procedure.

    They didn’t just send her a payment for no reason. They made a decision at the time and now want to revoke it.

  25. ThomFabian says:

    @Ex_EA_Slave:
    Two things:
    1) She went to them PRIOR to the procedure and received notice that they would cover 90% of the procedure. She relied on them doing so when she made the decision as to who was going to perform the procedure.

    2) They didn’t send her money. They agreed to pay a bill. You can’t go back 3 years later and say “Hey, you know that bill I paid in good faith? I want that money back because I shouldn’t have done that”. The transaction was completed in good faith.

  26. alice_bunnie says:

    @MsClear:
    Tell again about how we’d all be so much more badly off under a universal system?

    She would still be on the wait list or she never would have gotten the procedure in the first place.

  27. atrixe says:

    Ugh. Aetna did the same thing to me, albeit for a much smaller doctor’s bill {$250}. They called to alert me that it was a mistake for them to have reimbursed me, so that I would know for future claims. However, they admitted that it was their mistake and told me that I could keep the money.

    That almost made up for the time an Aetna representative told me that just because they tell me over the phone that something will be covered, that doesn’t mean that it actually will be.

  28. CrownSeven says:

    @alice_bunnie:

    Coming from a country with universal health care, I wait just as long for service in the US as I did there. Oh and thats IF my insurance would cover me for the procedure and/or I could afford the insurance.

  29. @Ex_EA_Slave:
    It just wouldn’t be Consumerist if someone didn’t blame the OP.

    So, we’re all supposed to be conversant in health care billing procedures now? It’s HER fault they told her they’d cover the bill and then they did and now they want their money back? Really? THAT’S the position you want to take?

  30. Coder4Life says:

    No one is signing up for our insurance. Hey I’ve got a great idea.

    Let’s screw over the customers we already helped. Lets go back and ask for money back.. What a great way to increase revenues while not increasing customer basis.

  31. Pithlit says:

    @alice_bunniealice_bunnie: That tired old talking point? The anti universal healthcare crowd is going to have to start doing better, because more and more people are for UHC all the time, as our failing system gets worse and worse. She may or may have indeed had to wait longer for the procedure, depending on various factors, but she would have been 100% assured that she’d not be denied it outright, and she’d certainly never see a bill for it years after the fact.

  32. Pithlit says:

    @Pithlit: She may or may NOT have had to wait… Ugh, I know I typed the “not”.

  33. coffee177 says:

    by MsClear at 04:51 PM
    Reply
    *

    Tell again about how we’d all be so much more badly off under a universal system?

    —————————————————————————

    Not a problem. Let me summerize it for you so you can understand:

    Its true that Suzy would not have had the billing error if we were under a “Universal” health care. She would still be waiting to have the procedure done. (Only one more year there Suzy, Hold on, We will get you in).

    Then the quality of the procedure would be lacking as well because most good doctors will move out of country to avoid getting paid a fraction of what they could get in ABC country.

    Of course, You can still gamble on Universal health. Leaving the sponge in, Mixing up your charts, discharging you too early, Oh and the fun one. Waiting forever to get in and then seeing that since you waited soooo long that now its cancer!

    Nice.

  34. Coder4Life says:

    @Ex_EA_Slave:
    That was 3 years ago you dumbass… What’s $7700 to them anyways.

    What if your electric company came back and said you know we made a mistake for 3 months 2 years ago. We are going to need you to pay up $1500 in overages..

    UH NO!!!

  35. MsClear says:

    I must say that the “free-marketeer” babbling gets quite old. But then again, I’m sure my “lefty lib” sounds the same to them.

  36. coffee177 says:

    Suzy, For what its worth, I would have a lawyer send them a nasty gram. If that doesnt work then take them to court. Be sure to file in the city you live as they will have to send their lawyers to that city to attend the hearings. If they file first you get to travel to where ever.

    Fraud comes to mind.

    Good Luck

  37. vdragonmpc says:

    Im still waiting for the money they owe me from procedures they called ‘experimental’

    Funny we are getting them covered under Anthem with no trouble and no ‘pre-approval’ BS.

    Tell them to get bent.
    Thats what they told me.

  38. MsClear says:

    All of the problems described by the “free-marketeers”:

    wait times
    medical errors
    chart mistakes

    All of these have happened in the US. It’s in the new all the time. Wrong leg removed and such.

    Personally, I experience mega waits to see the dermatologist, though I am insured. And no, it’s not cosmetic. I’m at high risk for melanoma. So I arrange my life around my six month checkups, because it would take eight or so months to reschedule.

  39. coffee177 says:

    OH. Remember there is no such thing as Arbitraton. If they force that on you then you might as well just pay that bill.

    Arbitration is for suckers.

  40. Jmatthew says:

    “Wait one year until many of last year’s charges are reversed saying further documentation is needed. Of course by then, receipts are lost, thrown out, forgotten. Aetna is apparently unable to retrieve the info entered at time of purchase or approval, leaving it to you to work it out. A Sysiphean task abandoned by most.”

    That doesn’t make any sense. You can spend the money on a health savings account any way you wish, but you’ll get penalized on your taxes if you spend it on anything other than health care or health care related items (yay toothpaste!).

    AETNA has no say in what you spend the money on, or on what you can write off on your taxes.

  41. levenhopper says:

    My family has United Healthcare, and we have six (6) months to submit a claim. After that, they’ll reject all claims we sumbit, because we didn’t submit the claim in a timely fashion.

    This issue deals with the same thing — just in the opposite direction.

    If they can limit me as to how long I can submit a claim, then it should go both ways.

  42. badhatharry says:

    What she should do is send them a letter stating that signing up with them in the first place was an administrative error, and she requests all previous premiums be repaid.

  43. Jeff asks: "WTF could you possibly have been thinking? says:

    @Black Bellamy:

    Thats good sh*t right there!!!

  44. NDub says:

    What? You guys haven’t heard of the “Just Kidding” clause?

  45. Mr_Magoo says:

    We have UHC; I work for a 50k employee company, and they did the same thing to us last year.

    My son had to have speech therapy. It was preapproved by UHC at an in-network provider. The sessions were twice/week at a cost of around $180/session. UHC’s negotiated reimbursement to the provider was about $100/session, and everybody was happy. This went on for over 2 years.

    In August of 2007, we got a bill from the provider saying we owed them $2700 for 15 visits which occurred in June/July of 2006, over a year earlier. We looked back at our records and verified that UHC had already paid for these (as well as all the previous and subsequent sessions).

    We called the provider, and they said that UHC had sent them a letter saying they wanted the money back, so the provider did it. We called UHC, and got a different story everytime we talked to them:
    1) This was part of a bulk recovery (UHC determined that the hospital owed them some money, so they arbitrarily decided to take it from our bill).
    2) The speech therapy wasn’t covered (even though we had a letter from UHC saying it would be)
    3) A computer foul-up
    Everytime we called it was one of these responses, and we got several promises that it would be ‘escalated’ and fixed.

    Even though the provider had originally been paid $100/session by the insurer, they wanted the full amount of $180/session from us!

    To top it all off, the hospital gave us 10 days to make the payment because it now showed as being a year overdue!

    We got the hospital to give us more time (ended up being 3 months) while we worked it out with insurance. I finally found out that our company has a person whose only job is to be a go-between for employees and UHC, and she had high-level access at UHC. She got it worked out after a couple of weeks.

    Then, a couple of months ago, UHC did the same thing again, for a different billing period. This time the company go-between got it worked out quickly.

  46. Tallanvor says:

    And my company wonders why I’d rather stay in the UK than head back to the states…

  47. camille_javal says:

    @MsClear: And, on medical mistakes – countries with universal coverage don’t have the same level of medical litigation that we have, because you don’t have to sue to get your medical bills paid when you are, for example, the victim of medical malpractice. So, instead, you see things like a no-fault system with a payment structure similar to worker’s compensation (to cover those things that go beyond medical bills), and panels of doctors discuss mistakes openly, in an effort to keep them from happening again. (I’m thinking this is Sweden…? I don’t have my reference around.)

  48. TechnoDestructo says:

    @MsClear:

    Don’t start this. We’ll just get a bunch of idiots spewing assumptions all based on Canada and the UK, because those are the only countries in the ENTIRE WORLD that have subsidized/single payer/government-controlled health care.

  49. asphix20 says:

    @MsClear: Likely you wouldnt have the costs of getting your tubes tied slip by under a Universal Care system.. but then again.. I’m just assuming thats whats going on here.

    Insurance companies are more often than not the devil.. but my instincts tell me this woman had her tubes tied (without a diagnosed health issue attached the lack of undergoing the procedure) and filed some sly paperwork generalizing the procedure (as she did here).

    That would make it appear to go through, but would raise alarms under a more scrutinous eye.

    Regardless.. I’m not a big fan of IOU’s after the fact. This woman has the right hands down given the circumstances IMO.

  50. Trai_Dep says:

    @Jmatthew: That’s precisely the absurdity of the SHPS situation. Had they NOT allowed the charges to go thru at the time of purchase, fine. Argue and win/lose. Had they flagged the purchase as questionable when my co-workers called to verify, fine, argue and win/lose.
    Had it not been something with tax consequences where you have to spend ’07 dollars in ’07, fine.

    The time to bring all of this up was in ’07, with months left, so at worst, argue, lose, use up dollars on a ’07 medical expense.

    The fact that Aetna waited almost a year, after clearing the purchase by okaying the CC purchase & verbally okaying it in a followup call lulled both coworkers into thinking their medical savings account was used up by approved charges for that year. And that their sundry purchase receipts weren’t as important, since the key benefit – according to the SHPS people – is “no more hoarding old receipts”.

    Despicable.

  51. Trai_Dep says:

    @Jmatthew: Oh, I see you don’t understand what pre-tax medical savings accounts are. You reserve money pretax that you must use by the end of the year, administrated by your insurance company. They give you a debit card for the amount you reserve that you use on medical expenses and verify that the purchases are valid.
    That’s how they get involved in this. The insurance companies like these programs since they make money off of the float for little effort. And, as it turns out, even less competence.

  52. StevieD says:

    Better go read the policy.

    Over payments (for whatever reason) are refundable to the insurance company. BUT (big huge BUT) there is a specific statute of limitations. Per the terms of my policy it is 180 days.

  53. SonicMan says:

    @Pithlit: Ya, it may be old. But Fact is Fact. An Old fact is still a fact.

    But hey, lets do it. We can all agree that taxes are not high enough right? We all agree that the Fed is very efficient, and would not possibly mess it up…..

  54. RumorsDaily says:

    If you go to court, rely on this:

    [en.wikipedia.org]

  55. There are a few things I would want to know to help out on this.

    1) What state is this in?
    2) Are claims paid with United’s money or with your employer’s money? (That makes a difference as state mandates would not apply to plans paid with your employer’s money.)
    3) What type of plan did you have, HMO, PPO, etc? There different requirements, both state and federal, for the different types.

    Without knowing these answers, I have 2 suggestions for you.

    First, go to your HR team. If you voice your concerns with your HR team, then the people picking the plan administrator should at least hear about the issue for future decisions. However, they might be able to reach out to a contact at United that can look into it.

    Second, go to your state Department of Insurance. If you file a complaint with the DOI in your state, that gets the attention of the insurance company. Most DOI’s require the insurance to respond within a very limited amount of time as well.

  56. keith4298 says:

    @Jinx: The hell with a lawyer…tell them that claims must be submitted with 6 months and she’s denying their claim. Then offer to let them appeal.

    Take your own medicine United (hopefully it’s covered and you won’t have to pay more than the co-pay)

  57. BruinEric says:

    My young son is battling cancer. We know other parents via our online support group in other countries who are desperately wanting access to some of the treatment methods, super-speciailized high-end equipment, and drugs we have available here in the USA. But the availability is very low or nonexistent.

    And there are certainly problems here in the USA as well. We see battles with insurance companies over covering treatments and drugs because many early-adopter procedures aren’t in their book of standard treatments.

    But based on our particular experience with rare and complex health problems, the USA has some of the best hospitals, scientists and available treatments in the world.

    All systems have their problems, and those believing a magical system awaits the US to solve all our problems are almost certainly mistaken. IMHO, this is a great CONSUMER story about a company doing something idiotic and needing pressure to get them to act sensibly.

  58. R-Star says:

    @coffee177: Have you ever lived in a country with universal health care? I live in England now, and I need to see a dermatologist frequently because I have severe psoriasis. In America, I had to pay between $20 and $40 (depending on the which insurance company I was with) to see a doctor who would keep me waiting for 45 minutes, talk to me for about two minutes, and then send me out with a prescription for another expensive medicine that would cause bone marrow and liver damage. Here in the UK, I’ve never spent less than ten minutes with my dermatologist, who has discussed with me the best options for my skin given my extensive history and worked to find the medication with the fewest side effects. And prescriptions never cost more than seven pounds. The NHS may not be perfect, but having experienced both systems, I’m happy to be living in the UK.

  59. spinachdip says:

    @alice_bunnie: Ah yes, the old canard.

    Despite all the waiting, somehow, people in countries with OMG SOCIALIZED MEDICINE live longer and are less likely to die from an amenable cause, while paying less per person and as a percentage of the GDP.

    Based on your argument, it makes waiting makes you healthier and saves you money. Put me on the waiting list, doc!

  60. spinachdip says:

    @SonicMan: Except it’s not a fact. It’s just a bunch of cherrypicked anecdotes.

  61. Ihaveasmartpuppy says:

    Ok, I’m going through a similar thing with Delta Dental. My son needed crowns on his 2 front teeth after an accident. A “pre-determination” was put through by the dentist (or so I thought, now I’m not so sure) for the procedure. The would cover $1,000 of it. We had it done. Now they are saying they will cover $0.00. WTF????? Can they do this after a pre-determination????? Help!!!!

  62. A few weeks ago, I was at an outpatient facility,waiting to go into the operating suite for cataract surgery. CIGNA had approved the in-network procedure, they’d pay $2000 and I was responsible for the other $2200. There goes my tax refunds. Anyway, the front desk person said that they’d just opened the claim with CIGNA and it was immediately denied, with the code for pre-existing condition. I had to cancel the surgery and I’m still dealing with CIGNA to determine what’s covered and what isn’t.

    We may have the best hospitals, best trained doctors and nurses, and fantastic equipment, but if you can’t afford it, it is worthless. Why is my employer paying $450 a month with me kicking in another $200? Why is my deductible $4000? Why are “maintenance” prescriptions (anything prescribed for more than three months) not covered? Oh yeah–choice and the free goddam market.

    Cue the posters blaming me for being an unhealthy whiner.

  63. rioja951 - Why, oh why must I be assigned to the vehicle maintenance when my specialty is demolitions? says:

    @coffee177: Let me be fully against that. I’m from Spain, Thus a UHC country and my high school friend that went into med school is now making more that any body in our generation.
    We go a long way especially since both of us went into the army, and even then he was making more than most of us that had the same rank, and when I say more than us do consider that we earned quite a living wage.

    So there. Of course I cant say much for the US health care, never been in a US facility, all my visits are business and never near a Hospital.

  64. failurate says:

    @coffee177: Doctors moving out of country… that’s a huge stretch and a flat out fictional lie. I know quite a few doctors, and they are not going anywhere no matter what the system is. They will continue to be high dollar earners.
    Your imagination (or someone else’s imagination) has gotten the better of you.

  65. bohemian says:

    Our previous health insurance tried this nonsense about 9 months after the fact. They suddenly decided that they didn’t owe the money first they said it was preexisting, then they said it was an accident so they were not the primary responsibility. All were neither.

    I spent way too much time over three months arguing and tackling what they threw my way. They purposely flood you with paper. The trick seems to be to dump things that require you to do or prove something with a short time limit in the hopes that you don’t do it.

  66. MPHinPgh says:

    @Ex_EA_Slave: You don’t know that. In fact, NONE of us KNOWS exactly what the circumstances are, so you can really draw NO conclusions.

  67. am84 says:

    @BruinEric: I wish the best for your son. My brother got cancer at at 3, was told he wouldn’t make it to 6, and is going to graduate high school next month. So, there is always hope. :)

  68. Juggernaut says:

    I’m sure she didn’t submit the claim. The doctors office submitted it and the insurance company paid the doctor. I think Sue and the doctor performed their duties in accordance with accepted procedures. Sue needs to get the doctors insurers (malpractice and business) involved which would probably stop this in it’s tracks.

  69. spinachdip says:

    @coffee177: Of course, You can still gamble on Universal health. Leaving the sponge in, Mixing up your charts, discharging you too early

    Funny you should mention discharging too early, because that’s precisely what insurance companies are pushing these days. Case in point, when our daughter was born, we were discharged 36 hours after the delivery and the hospital failed to detect jaundice, so we had to be readmitted for two extra days under the bilirubin lights.

    Essentially, they tried to cut costs by discharging early, a policy meant to cut costs, a shorter turnaround, ended up costing them more, not just for the treatment but for the extra paperwork for readmittance, which they could’ve avoided by having a more reasonable timetable for recuperation, not to mention they missed a serious (albeit easily detectable and treated) condition.

  70. @Sir Winston Thriller: This actually is a very different situation than the original article, other than involving insurance, but this info may actually help you out.

    Due to HIPAA legislation in the US, if you have prior group health insurance, without too long of a break, you can get credit towards the 365 days that the pre-existing condition limits could impact your coverage. If this is the case, your prior carrier can supply a letter of credible coverage. Submitting this to your new coverage can meet some or all of the period you would have to wait for the limit to pass. Also, if your new employer has a waiting period before your coverage can begin, the gap in coverage goes from the end of the prior coverage to the beginning of the waiting period, but the waiting period doesn’t contribute towards the number of days met on the pre-existing limit.

    If you did not have a prior medical coverage or the gap between the 2 was too long, then it may depend on whether you had received treatment or diagnosis of your condition prior to your effective date. Your physicians can help out with that by providing the information to your insurance company.

    I hope that helps you out.

  71. Craysh says:

    @failurate
    And how would the remain high income earners when the government decides that they’re making too much money and need to make budget cuts?
    Would you as a doctor, like to make as much as a teacher?

  72. vp_bsu says:

    Wow. There’s a lot of bad information being thrown around here.

    Too many details are missing from all of the insurance stories to give accurate answers.

    To all of you, I suggest looking up a “Medical Claims Advocate” in your area. These are people who are skilled in dealing with sorting out billing and claims errors. Most will give free consultations over the phone.

    Here is the website for the Alliance of Claims Assistance Professionals. You can find someone near you on this site:

    [www.claims.org]

  73. NotATool says:

    @coffee177: “Of course, You can still gamble on Universal health. Leaving the sponge in, Mixing up your charts, discharging you too early, Oh and the fun one. Waiting forever to get in and then seeing that since you waited soooo long that now its cancer!”

    Thank god this never happens in the current US healthcare system.

    Is it arrogance or brainwashing that prevents people from admitting that, gosh, our system sucks, and, gee, there could possibly be a better way, and — oh my god — some other countries are already doing it!?? No, couldn’t be, this is the USA and we’re the best of the best.

    It’s like someone handed you a turd to hold on to, yet told you it’s the best thing in the world. Nevermind that it smells like a turd or it’s brown or is all squishy and it *was* warm when you first had it, and that people from other countries are saying, eh, why are you standing there holding a turd?

  74. sodden says:

    @Msclear and etc: You’d have some really good points if you were really arguing against a free-trade health care system.
    But what we have is a corporate based health care system right now. If anything, it’s closer to being like a universal one than like a free trade one, in that someone other than the consumer is paying and someone other than the medical profession is deciding the costs.
    This is like saying we should give everyone free cars because the car insurance industry is out of control.

  75. MrEvil says:

    I think it’s useless trying to convince the free marketeers that there is indeed a better way. Yeah we have choice in the marketplace, but it’s between constipation and diarrhea. The only “choice” we have these days is between varying degrees of shit plain and simple. Unfortunately too many people are blinded by assholes like Rush Limbaugh and Michael Savage to think for themselves.

    Y’know, there are folks in this country with some conditions that can’t get insurance at any price? Folks with Diabetes for example, most insurance companies won’t carry them and blame any health problem on their pre-existing diabetic condition.

    Hell, I can’t get insurance at any price either, at least not to cover any Mental health treatments, insurance company will just say “pre existing” as the magic words and deny any claim. Heck, United Healthcare denied me a mental health claim despite having NEVER Been diagnosed or treated for mental illness before. I told the hospital that’s STILL trying to collect from me to get bent and take it up with UHC.

    We definitely need the Single payor system BADLY. All the free market has done is given carte blanche for the insurance companies to fuck every American in the ass. I won’t bother to pay for insurance anymore because it’s a crap shoot weather or not the motherfuckers will pay.

  76. mikelotus says:

    It is estimated that 27K Americans die every year due to not having health insurance.

    UHC sucks. They are the worse insurance that I have ever had or heard of. They just announced a bad quarter and they keep loosing customers. What a surprise. Empire BC is like heaven compared to them and in the end, much cheaper. If UHC was removed from this earth, then life would be better for us.

  77. Nomine69 says:

    TechnoDestructo.

    UK and Canada being the only contries with it. Dang, I must have missed something during those 22 years living in Norway and the 5 years in Sweden, Because I was pretty sure we had it. After all every medical bill and drug was covered by the state. Except a small personal fee of around 20 USD pr visit, or 16 USD pr day in hospital.
    Waiting times being longer.. yeah it happens in Norway, it happens in the US. I take my chances on them in Norway, instead of taking my chances on a possible insurance coverage.

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

    UHC is the crappiest, most useless insurance company I’ve ever had the displeasure of having to deal with. I was very happy when my company “fired” them & went with another provider.

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

    @Craysh:

    Yeah, doesn’t work that way *at all* in Germany. Please actually do a little research into countries other than Canada before you start spouting bullshit. Thanks.

  80. BigElectricCat says:

    @Black Bellamy:

    Are you an attorney? Can I get you on retainer? :)

  81. BigElectricCat says:

    @coffee177:

    “Not a problem. Let me summerize it for you so you can understand:”

    Given that you’ve substantiated none of your ‘reasons,’ you’ve only presented opinion, not fact. That’s all well and good, since you’re certainly entitled to your opinion, but taking a condescending attitude simply because you don’t agree with someone else’s opinion is quite rude.

    IOW, I disagree with your opinion, but I’m not being a d*ck about it. Maybe you could try that yourself.

  82. pwillow1 says:

    The state where I live has laws about this very practice of insurance companies trying to recover money paid for claims, and I would suggest that this woman contact the insurance commissioner in her state to find out if her state has similar statutes. This is so, so wrong.

    There are companies that specialize in this type of benefits recovery — they hire themselves out to insurance companies with the promise of recovering x times the amount it costs to hire them. I have had physician clients get these letters asking for repayment YEARS after the services were paid for. This is how I became aware that my state has regulations against this practice.

  83. Balisong says:

    @smirky: Good point. In my last temp job, I had to send letters to people demanding money for waaayyyyy overdue bills. (Christ, how I hated that job…) If they paid, good for the company. If they didn’t pay, there really wasn’t anything the company could do because the bill was so old and the legal fees would outweigh the money collected if they actually won (and then they probably wouldn’t be able to collect anyway). But since this is such a large bill, definately check the statute of limitations on this. But I doubt they’re going to try to collect on this. Even if they win a court case, they know a bill this large along with legal fees would likely send someone into bankruptcy, and then of course they’ll still never collect.

  84. Balisong says:

    Oh wait…$7700…I guess that wouldn’t really mean bankruptcy. I guess I was being overly pessimistic about the economy there for a second :x

  85. RINO-Marty says:

    I was the guy who wrote the Consumerist post about CIGNA retroactively unapproving a surgery they had preapproved and demanding $9000 from me.

    They admitted they had approved the surgery, the hospital, the doctor, and the fee. The hospital verified all of that in advance. So did the doctor. Then I got the surgery and they unapproved it 4 months later.

    Here’s what you do – fight, fight, fight. There’s a company in New Jersey that specializes in reversing denials-of-claims. Hire them. Have them file an appeal for you. Then, file an appeal of your own. If they’re denied, keep re-appealing. Over and over. Never give up.

    Also, call your state insurance commission to see if your state permits robbery of this kind. I live in Ohio, and I was told it was perfectly legal. Their precise comment was, “Mistakes happen, sir.” Ohio’s insurance commission is nothing more than the collections arm of the band of thieves known as the healthcare insurance industry.

    Then, vote for politicians who promise to nationalize companies like CIGNA and AETNA and throw their executives into prison for life.

  86. bobblack555 says:

    How do insurance company employees sleep at night? Seriously!

  87. evilinkblot says:

    I’m in the insurance business. What most people know about the Universal systems in other countries is straight from the mouths of talk radio personalities and bears little in common with the truth. I have friends overseas who love their system and can’t imagine ours. Like it or not, on this topic, Sicko was very accurate.

  88. Rectilinear Propagation says:

    @Black Bellamy: You win the thread.

  89. satoru says:

    [www.npr.org]

    I found this article very interesting read. How ironic that in Japan that hospitals are closing down because health care is TOO CHEAP!

    Though to be ‘equal’ my brother lives in Japan and hates how the doctor-patient relationship works. It’s very ‘I am the doctor and I am god’ kind of thing. They don’t really share information with you, and if you try to ask or even question them, they become defensive and even hostile. He’s not a big fan of them :P

  90. RINO-Marty says:

    I wanted to add something to my post above at 11:10. After the executives at CIGNA and AETNA have their companies nationalized and then go to prison, I want to wait until they die of old age or disease or a prison riot, and then dance on their graves. Then I will find their children and tell them that their parents were bad people and deserved to die, and are now in hell. And when their children cry, I will lick up their tears and savor them.

  91. woolygator says:

    The last 100 drugs that the FDA approved only 43 were approved in Canada, because some faceless braucraut said that the other drugs were too expensive for canadian citizens. And you guys want that!!

  92. hexychick says:

    @Ex_EA_Slave: Are you kidding me? Do you even have health insurance? Most company’s will cover out out network but only a certain percentage, for example: My insurance is 100% in and 70% out. This woman did everything right and checked before her surgery. Leave it to you to be the blame the victim commenter in this thread.

    To everyone bucking universal healthcare – have any of you ever actually lived in a country with it or do you just get yourinformation from websites like Consumerist? I’ve got friends in various countries around the world who don’t have any of the problems listed nor do they have to wait for surgery for a year.

  93. trujunglist says:

    @Coder4Life:

    Wasn’t there a story about that recently….

  94. mwilliams3609 says:

    I work for an insurance company and what I suggest you do is appeal it through customer service. Call every day and then let them know that you are going to file a complaint with the Dept of Insurance. I know personally, that once we have someone that takes a claim to the dept of insurance, those cases are handled as a priority.

    When anyone calls in to our customer service department, there is a log of that conversation on our computer system. When you call into customer service to ask/file an appeal, ask them to find the record of your call where United said that they would process this claim at XX% of benefits. When you called United, they gave you a mis-quote of benefits. The company I work for, we have to honor that mis-quote. So that would be my first step.

    As for the Dr’s office, they knew they were out of network for this woman and they should have been the ones calling for an auth.

    So, Call United and get them to admit to a mis-quote and start the appeal process. Second, contact your states Department of Insurance and file a claim and then notify United that you have filed a claim. Also, call every day to find out if anything new has happened. Being a pain really does work, at least for my company. The more someone calls, the more they complain, the more likely people will be to do something so that you stop calling.

    I really hope everything works out for you.

  95. jimconsumer says:

    Suzanne: If your appeal does not go through and they continue to insist on payment, simply refuse. No, I am not kidding. Tell them to go jump in a creek. DO NOT PAY THEM ANYTHING. Not a single penny. Do be prepared to switch insurance companies, but you should do that after this fiasco, anyway.

    They can not “take” the money from you. They can not FORCE you to pay them. Can they sue you? Well, technically, yes, but I’d be really surprised if they win and you should NOT have to hire an attorney.

    So, step 1: Try to work it out with them, but do NOT agree to pay ANYTHING. Don’t even let them talk you into paying half, etc. Don’t give them a penny.

    Step 2: If they insist, simply refuse. Shred their letters. Don’t answer their calls. Tell them to jump in a creek, you’re not paying.

    Step 3: If they send you to collections (they will), inform the collections agency this is an invalid debt that you DO NOT OWE. There are easy to follow procedures for dealing with debt collectors who are harassing you. Follow them.

    Step 4: If they do eventually sue you – highly unlikely – don’t freak out and waste money on a lawyer. Show up to court dressed nicely and remain calm. When it’s your turn, explain the situation to the judge: You had a procedure done, they paid for it, two years later they changed their minds. Explain that you never signed anything agreeing to be responsible for this debt and that you are not responsible for their error. Worse case the judge will make you pay it. But I highly doubt they will take it this far.

    As for “Can they do this?” Sure, anyone can “demand” money from you. I can send you a letter demanding money from you, too. Just because someone demands you pay them doesn’t mean you have to. I regularly tell people to go jump off a fucking cliff with their silly bills or bullshit charges. In short, I refuse to pay when I don’t legitimately owe the money and you should, too.

    When they scream and threaten you, ignore them. When they say, “I’m going to sue you!” Tell them to go ahead. They like to make threats. They rarely follow through.

  96. Consumer007 says:

    Hmmm….the next step in what Republicans want – no health insurance for anyone ever no matter what, because unless they are rich people deserve to die in the gutter.

    Isn’t it amazing how disposable everyone is to Republicans and health insurance companies?

    Needless to say, their approval and payout of the charges is a contract and they can’t go back on it. Duh.