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.

Here is how they discovered the error:

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

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......

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

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.

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."

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

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).

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

"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...

UnitedHealth: "Put your sticky hands up! This is a f*ck up! Oh damn! Wait a minute..."

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....

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

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!

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.

@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

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.

@Black Bellamy: That was beautiful!

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

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

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.

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.

Phew! Thank God she was insured! Otherwise, she wouldn't be able to avail herself of the Best Healthcare In The World™.

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.

@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.

@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.

@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.

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.

@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.

@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?

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.

@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.

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

by MsClear at 04:51 PM
Reply
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Tell again about how we'd all be so much more badly off under a universal system?

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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.

@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!!!

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.

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

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.

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.

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.

"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.

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.

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.

@Black Bellamy:

Thats good sh*t right there!!!

What? You guys haven't heard of the "Just Kidding" clause?

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.

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

@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.)

@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.

@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.