United Healthcare
April 4, 2008
Several states all over the country have been filing class action lawsuits against the insurance giant United HealthCare. The general public continues to believe that physicians in this country are all millionaires and are just in the practice of medicine to make lots of money. In this day and age nothing is farther from the truth except for perhaps the elective plastic surgeons who work on the boobs and botox end of the spectrum. The reason the plastics practice can thrive is because most of there work is not covered by insurance so they can actually collect what they charge for their services and make a living. Physicians these days are pretty much under the control of insurance companies who are in charge of what they make. The ones that are making million and billion dollars worth of money each year are not the physicians who are out there on a day in and day out basis but the insurance companies that control every aspect of healthcare. United Healthcare is on of the worse in this writers opinion. They pay their physicians at a less then adequate fee schedule and reimbursement at some procedures is less than the medicare and medicaid fee schedules. United Healthcare also employs such a hiarchy of complicated measures to actually get a claim paid correctly that some physician offices waste more time and money on trying to get paid then the actual claim itself cost. This is no doubt a direct tactic for this insurance company to pocket even more money. Physicians have lost all control over there financial situation when it comes to dealing with United Healthcare. This company is completely out of control on their deceptive trade practices with physician and hospital entities. They continue to pay physicians at lower than contracted rates and then they only fix the problem if a class action suit is brought against them. They are the most unreputable insurance company out there in my meager opinion. They use unfair tactics and there profit margin is beyond imagination. UHC is growing at a rapid rate and it is up to the public and physicians to stop them from there unfair and deceptive practices. I have yet to find any physicians that I have spoken with that are happy with this company. It sure does make Canada and universal healthcare seem like the only way to actually get control out of the hands of these profiteering insurance companies and back in the hands of the American public and the physicians who take on the daily tasks of caring for these individuals regardless of the levels of reimbursment that they are being paid.
I work United Healthcare denials everyday. We are considered a “blind” or “uncontrolled” provider. These providers are the Radiologist; Anesthesiologist; Pathologist; Lab, and Emergency Room Physician. The term United Healthcare uses, internally, is “RAPLE” providers. As a non-par Radiologist, of course, depending on the patient’s “benefit plan” claims are suppose to be paid at the “in-network” benefit level, Being a non-contracted provider, when the patient presents to a par-facility (hospital), the claim is supposed to be processed and/or considered at the “billed” amount, not their “usual & customary” or their “reasonable & customary” amount. United Healthcare uses the term “eligible expense”. What most providers and patient’s do not know is that they are suppose to consider all charges at the billed amount. These RAPLE providers actually get a better return if you are not a contracted provider. What the insurance companies (including United Healthcare) fail to inform their providers and members is that when a patient presents to a participating hospital (facility) United Healthcare is suppose to enhance and process at the “in network” benefit level even though we are non-par. Recently, as part of their strong-arm tactics to force physicians to participate they have decided not to honor our “assignment of benefits” for small group employers only . That means, if we file a claim on the patient’s behalf who has a private policy or a small group policy, United Healthcare will pay the patient directly for our services. BCBS used to do this to us when were were non-par. We just had too many BCBS patients, therefore their strong-arming tactic worked, and we joined them. Even as a par-provider with BCBS, they still process our claims incorrectly. They are forever paying the facility (hospital) claims, however denying our claims. They actually try to get away with paying for 1/2 of the claim (we bill for the “PC”=professional component and the hospital (facility) bills for the “TC”-technical component.) They try to get away with it. **The important thing to remember is that you have to keep on top of your denials. You much work them. I call United Healthcare, CIGNA Healthcare, and AETNA, pretty much on a daily basis, getting them to reconsider and reprocess our claims to be enhanced “in network” and considered at our billed amount and not their allowed or eligible amount. It takes a while, several appeals, however, most of the time, they actually end up paying. I am a physican and patient advocate. We are a small group however I have recovered over $500,000 in the past 4 years. They may not see like much, but that is $500,000 less that the patient had to pay us because insurance companies like United Healthcare continue to get away with what they do. If these insurance companies were investigated, it would probably pay the entire 1.3trillion dollar deficit that the new President Elect is going to inherit. I wish he would contact me to work in the White House, I definitly could get some serious financial recovery for the entire United States of America.
**If there is anyone that needs my help and expertise with getting claims paid and that goes for physicians/providers or patients, please feel free to email me. I guarantee you I can help and may also be able to recover some of your money.
On August 9, 2008 I was involved in a really traumatic bicycle accident while training for a triathlon. As this wasn’t stressful enough, what I’ve been going through with United Healthcare (UHC) has been even more stressful. A stress that no consumer should ever have to go through.
The first problem was having to battle with them for paying the emergency care I received. Most of the bills weren’t paid on time, and thus I was receiving notices from doctors’ offices stating that my bills would go to a collection agency if I didn’t pay them. There are still outstanding bills that they have yet to pay out, and I’m having to call them 3-4 times a week just to follow-up. I can be told by an UHC representatives that they will send the claims to be reprocessed, but in the end it never gets done. There has to be continuous follow-ups on my behalf or my wife to get them to make an inch of progress.
The second problem is their refusal to authorize a bone grafting and dental implant procedures to perform reconstructive surgery that I sustained from the bike accident. I have already gone through my 2nd and last level of appeals already, but all I get back is a denial of coverage. Their reason is as follows:
“Dental services to repair damage caused by accidental injury must confrom to the following time-frames:
- Treatment is started within three months of the accident, unless extenuating circumstances exist (such as prolonged hospitalization or the presence of fixation wires from fracture care).”
In justifying my extenuating circumstances the doctors that treated me recommended that I wait at least four months for the fractured jaw bones to heal properly to achieve the optimal success for the dental implants. I followed my doctors expert advice, but UHC doesn’t agree that this was valid.
I’ve been told contradicting things from UHC representatives on the above policy. Some representatives were convinced that if UHC received a letter from my doctor explaining the reason why the procedures could not have started within the 3 months time frame, they would approve of them. The end result was just this disappointing denial of coverage response.
The biggest complaints against UHC are their disception, dishonesty, and failure of practicing good faith with the consumers such as myself. Between my wife and I, we’ve made hundreds of phone calls to try to push for the approval (yet they expect us to move in a timely manner). First we’ve told there wouldn’t be any problems of the above mentioned procedures being covered, but the actual result was the opposite. They do not follow through with anything they verbally promise you. They had promised me a decision to be made within 72 hours a number of times, but when that deadline comes, I always have to call (only to be disappointed that they are still investigating it). There is also that frustration of having to deal with a different representative every time you call. Each time you get a new representative she/he doesn’t understand the full story. You then waste a couple of hours explaining the whole situation, only to be told something different than what the last representative told you.
I feel powerless and hopeless against UHC, and the level frustrations have affected me and my family to no end (not only financially but also emotionally). I was wondering if there’s anything further I can do against UHC.
Cordially,
Meng
This may be off-subject for this partciular issue - Yet I have United Helth Care for my Medicare Prescription Part D benefits and have had touble for years. Denial of medication, processing of claims slow and or explanation-less with due process and logic.
This keeps happening. UHC also dropped my old Plan Coverage from last year and cancel the plan and without my knowlege swiched me to another plan without my concent which also has different coverage than my previous plan..
In any case it’s a mess….
If anyone can help or offer assistance please contact me..
Respectfully yours
Robert
Sue the hell out of them . they denied my claim to have surgery on my nose so i can breathe. About two years ago. I was working in NJ and NY and i was going to a dr about every month. well i had gone back to Iowa for Christmas, I was going thru my mail and i kept seeing these pre-existing forms to fill out. I had 30 days to fill them out. Well i was in NJ and NY in July of 2007 and i didnt go back to Iowa until dec of 07 so i was way past the 30 days. I called them to explain to them that i was out of state when they sent them forms. I had ask them to send out new forms but of course they never did so those doctors bills are on my credit now. and they wont do anything about it.. So now i am I am not a sue happy person but i am going to sue the shit out of them. they want to screw me , deny my surgery and not pay my doctors bills. Not this time they are going to pay dearly. SUE SUE SUE SUE the hell out of them MENG dont take that crap from them anymore
I work for a large corporation and have UHC as my insurance provider. It is supposed to pay 100% for physicals and preventative care. Because of “coding errors” it did not. Talking to representatives is useless as no one takes accountability. I’ve taken it as far as I can go with appeals and I got form letters saying the claims were processed correctly with the codes used, (codes which UHC reps already admitted to me already were in error.) I find I’m not the only one in my company who has this problem and wonder if my problem is the tip of the iceberg. I also find that some top surgeons and doctors are refusing to take any insurance in my area because they do not want to deal with these kinds of issues.
Rosen Myer wrote:
**If there is anyone that needs my help and expertise with getting claims paid and that goes for physicians/providers or patients, please feel free to email me.
I do billing for a neonatal group and am having serious difficulty getting a straight answer from United on their coordination of benefits policies. I also have issues with out of network claims with BCBS that I’d like to discuss. I’d like to accept your offer, but I don’t see your email address. Please contact me.
Looks like my email address does not get posted on this forum, which is what may have happened with Rosen Myer as well. It is neocutchen at aol dot com
United Healthcare is the most corrupt company I have ever encountered. I live in Massachusetts, which is a ‘good’ insurance state, but UHC became the ‘plan administrator’ for HarvardPilgrim, (or the enforcer). Our insurance is thru my husband’s employer, Osram Sylvania, and it is an ERISA company, so we have little recourse. This is a license to steal on UHC’s behalf.
My child needed occupational therapy and UHC paid for nine months w/o complaint, then abruptly stopped paying, claiming it was experimental. We actually have HarvardPilgrim insurance and the provider had a contract with Harvard Pilgrim! Who contracts with experimental providers?? We cannot afford to go after them but would love to join a class action suit. They cheated us out of 25k, with Sylvania’s blessing, and when you multiple it by thousands,, well, it becomes millions.
Our lawmakers need to do something about corrupt companies like this.
They are continually denying claims and we have to call and spend 30 minutes having the same discussion with yet another person from “rapid resolution”.
It is sickening that one’s employer would subject their employees to this treatment.
Patricia
I am a pyschologist and not a provider for United Healthcare, but was paid as an out of network provider for many years. Several years ago they sent me numerous faxes asking me to join as a provider and they would pay me less. I, naturally, did not sign any of these faxes. About 3 years ago, they started paying me as a provider, which was about half. My billing service called repeatedly and was told that without a provider number, which I did not have since I am not a provider, they could not look me up and therefore they could do nothing to get me off their list. The insured had supplemental which paid most of the difference.
Recently, after I told his this saga, another client with the same insurance called United himself. After a month or so, a customer service rep produced an agreement that I signed in 1992 with another company and said that that 17 year old document was proof that I was a provider. They have never informed me of that, asked for proof of licensure or malpractice insurance or certified me as a provider for them.
I am not accepting this as legal, and certainly not as ethical.
Any suggestions? Have other people had this happen to them?
Thanks,
Marjorie
UHC has always been more hassel then profit turning. And come to find out today their customer service reps that you call for verification purposes and other questions is located in INDA why are they dealing with UNITED STATES insurance and health care????? they have all our information then as well social security numbers telephone numbers and i doubt the hippa laws can protect us over there.
I would like to see the insurance companies (of which, UHC is the worst) have to pay $100/hr for all the time that is required to get a claim paid that should have been paid in the first place. If a $100 claim starts costing hundreds extra you would be amazed how good their customer/provider service would become.
I own a small diagnostic company and we are certified by Medicare and are in-network with most insurance companies except United Healthcare. I tried to get in network with them when I opened my business and was told ‘we are not accepting new applications at this time.” we continued to provide our service to patients with UHC because they need it. My company just ate the cost. It seems that we are getting more and more patients with UHC coverage, so we are having to deny our services. I have called many times to get in network with UHC and they just say the same thing ‘we are not taking new applications at this time.
I would like to join a class action suit - these people are just robbing the most vunerable population and do not care about their health at all. Theives
Ditto here. Getting reimbursed from United for what they say they cover has been a nightmare. I have stayed with them because it was what my employer offered and less expensive in the end since my employer was paying so much of the enrollment. Still, at this point United has thousands of dollars that I have not been reimbursed. I try to call them and work on the biggest cases as often as I can but that doesn’t mean they send me money.
If someone is putting together a class action against United I want to know.
I was midway through my cancer treatment at natioanally known center when the self insured employer which Ive been with 17 years switch to United Healthcare to manage the insurance .I went from excellent coverage Jan 1 to fraudulent coverage from innetwork to UHC favorate phrase out of network and will only pay the aceptable rate for the regional area.Yet this nationally renowned Hoapital has been mentioned more than once by the President of the United States as a model to follow for national Healthcare because of low cost and eceptional outcomes.Yet UHC processing has declared my claims as some of my surgery uneccessary, 29% of total charges above the regional charges ?The 45 days for processing claims are more than double if you can get a reply.It the same pattern they been fined for but yet they’re still in business.Please contact me at dorton@cardiac.creighton.edu so we can put this ponzy scheem where it belongs
Back in October of 2009 my then 2 year old daughter became ill and was breathing rapidly, coughing and wheezing we tried to let it run its course thinking it was viral but her breathing got worse so my husband took her to our primary care physician. She was struggling to breath so much that she grunted after every breath, her rib cage looked tight and she was wheezing. Our primary care physician did an exam, nebulized her (she used albuterol) then asked my husband to take her to the emergency room. This was at the height of the H1N1 outbreak that everyone (including myself) were terribly afraid of. I met my husband at the hospital entrance and when I removed my daughter from her car seat she vomited all over me. So the ER dr. performed some tests including the H1N1 test where they swab her nostril and send for a quick response test, it came back negative. He winds up diagnosing her with an upper respiratory infection and sends us home with a nebulizer. Well, my daughter never fully recovered and continues to cough and wheeze to this day. On Monday the 19th of April she was diagnosed with Asthma. United Healthcare refuses to pay the insurance claim for $961 because they feel the upper respiratory diagnosis was not a good enough reason to take our daughter to the ER. I informed them that our primary care physician instructed us to do this and that had we ignored my dr’s instructions and our daughter died, we could be held accountable for her death and potentially prosecuted for child neglect. Didn’t matter. They denied the claim twice, the second denial came after our primary care physician wrote UHC a letter explaining our daughters symptoms and what lead her to refer us to the emergency room. I’m more upset at the fact that I pay United Healthcare to provide health insurance to my family yet they refuse to honor their commitments. I want to start a class action law suit. I don’t know where to start but I’m sure there are other people out there just like us. UHC needs to be put in their place. LCastelly26@Yahoo.com
Thank you for share. This information of United Health care is useful for me.
Dealing with my United Health Care/ Pacificare claims has been worse than I could ever imagine, the most grueling ordeal in my life. They denied most of my claims for prostate cancer treatment but eventually paid them after months and months of persistent follow-up. I still owe about $1,000 on bills declined because of out off network providers used during treatment. I received the notice on the class action lawsuit that appears to be a bad deal. It correctly identifies the fraudulent UHC practices I have encountered. If I am reading it correctly, I would receive payment -70% and then pay 20% to lawyers. So I would be reimbursed about $240 if I agree to the class action terms, nothing if I do not respond or can deny inclusion in the suite and pursue legal action at my own expense. So as I read it I would still owe $640.
I find myself cured of cancer but out of work with dismal employment prospects and ever dollar counts. If anyone has advise, are aware of any other class action lawsuits or lawyers that I could contact, please please please ….. let me know.
Thanks Much,
nick985 at sbcglobal dot net