United Healthcare to pay $12M to settle complaints

This is likely a "tip of the iceberg" that has become public. I have United coverage and not only does it not pay anything, it fails to provide EOBs and the EOBs it does churn out are full of errors--in both cases delaying payments from savings accounts. This is prime territory for a class action.

I completely agree with the monitoring of United Health Care. I have two emergency room claims,for my son, that have been waiting 5 months to be paid. I have received multiple excusess from United Health Care. First they told me my son had another insurance, which he doesn't. Now they are saying that he is not a full time student. He is 13 years old, what else would he be? The whole situation is ludicrous and very frustating. Either United Health Care is completely incompetent or commiting fraud.

As a medical biller I can say that UHC is completely and utterly incompetant. They have moved their claims processing/customer service issues to India where the representatives have absolutely no clue what you're asking them. I have been hung up on, forwarded to another extension and left holding for over an hour when ever I show frustration about having to call them for the 4th or 5th time about the same claim. Claims that are denied for timely are sent in on paper with proof of timely but then again denied. This company is the WORST and part of the problem is that you have no other number to reach them at other than the CUSTOMER SERVICE line. This company is going to go under with all the complaints to the insurance commission. If you have a choice on who you have for your insurance plan, do yourself a favor and save yourself alot of stress and DON'T CHOOSE UHC.

Commercial health insurers deliberately hire the people who first review medical claims from the bottom rung of the employment laddder. These people are poorly trained, poorly educated and poorly paid. They make mistake after mistake and are the intial cause of so many billing errors, always, of course, in the insurer's favor. This is deliberate policy on the part of the insurers. You can bet that the insurers would never tolerate such poor quality and errors from their accounts receivable staff.
'Its only business, nothing personal', as Michael Corleone said.
Howard (in the business 4+ years)

Howard, I hear you. But wouldn't doing that rebound on the health plans in other ways?  After all, they do pay *some* claims at least, and making that inefficient must put some drains on managerial time there--plus open them up to contract disputes. Not only that, in any business, getting cash out the door to those who are owed is important in keeping the books balanced, isn't it? It's not that I'm arguing with you, just wondering how hiring unskilled employees helps the health plans any. After all, one could argue that hiring fewer (smart, qualified and crafty) employees would get the same job done without imposing a drain on the organization.

Yes, Anne, you are correct. "Clean" claims submitted electronically would normally sail right thru the initial review process. However, any claim that has any kind of discrepancy, an incorrect modifier, a procedure performed in a state different from the residence of the patient, a physician fee over a certain limit, etc. will normally end up on the desk of a human being, and that's where the problems kick in. I travel to work in the a.m. with people who work as medical billers for one of the largest 'blues' in the East. Most of the billers are temps, and very few get their contracts renewed. The average biller turnover at that particular blue has to be close to 100% annually. What kind of quality of work are those kids turning out?
Howard

The comments scare me - especially re: outsourcing to India. I had brain surgery in October. I just received an EOB for a doctor who I don't even know. She is a Neurologist and has the same Surname as the Neurosurgeon who did in fact operate on me. On that same day in October, two (2) Dr. "Z"'s in two (2) different states operated on me! I called United on Friday and the lady just didn't "get it". How hard is it to get? I could not be under the knife by two (2) doctors in two (2) states on the same day. Where are the checks & balances? I have just begun the process of trying to unravel this mess. My Deductibles and Out of Pockets, both IN and OUT of Network, are all messed up. And you can imagine the costs!

UHC is denying office visits for # of units reported exceeds the typical frequency per day. I called uhc & was told that this is another glitch in the uhc system. I also called today for benefits on a patient & was told that her wellness benefits were unlimited. At the same time I was going over the benefits on the website & noticed that there were no routine wellness benefits for labs & xrays. I questioned this & was told that the wrong info was provided & that the website was correct. There are too many mistakes being made by uhc on claims processing & benefit details. Physicians are questioning their billing depts about UHC unpaid claims & it really sounds unreal when they are told of the processing errors made by UHC. I am thankful that I work for a great group of understanding DOCTORS!! I know there are some doctors out there that think their billing staff needs a little more training because with a company the size of UHC there is no way that they could make this many errors on claims processing & benefit details. GOOD LUCK TO EVERYONE--I REALLY DO THINK UHC WILL RESOLVE ALOT OF THE PROBLEMS IN THE FUTURE OR AT LEAST I HOPE SO......

I have been on the phone with uhc at least 12 times in the past 3 weeks. Due to a system "glitch" they cancelled coverage on my daughter. They stated they reinstated it, but when we made a midnight trip to the ER, we found out that she was still not covered. They stated they corrected it now, but its still showing she has no coverage. I also have a dependent flex account with them, and they keep stating that they paid the claim I filed almost 3 weeks ago (they state the turnaround time is 1-2weeks), but no payment was ever made. I've called them twice a day for the past week, and everytime I hear a different reason, them going so far as to boldface lie to me and say it was my bank that was "stealing" the money from me. Give me a break!

Had my Cobra Lifetime coverage cancelled because I missed a payment that I never received and was returned to UHC as undeliverable. As it turned out UHC showed an extra 0 in the middle of my address although every other piece of mail including previous bills came to me with the extra zero in address which I never noticed. Have filed appeal and I am not holding my breath

I have had nonstop problems with UHC. They aren't paying the claims on time and there was one claim that I had that they said wasn't covered because the ER coded it as a back ache. The hospital clearly said they had not that It was stomach pain and vomiting. UHC stood their ground. The hopsital sent me to collections and now collections is battling them with a not for appeals from my doctor. Then in October I had to have a procedure. The doctors office sent all the information to predetermination dept and it was approved with an approval number (verbally but there was a confirmation number) Then they said they needed more information and contacted the doctors office. That same day they sent me a denial letter but kept working with the doctors office to push my claim through. The docs office assured me I was covered. Went in the day to have the surgery and the docs office called the surgery dept to tell them that UHC had called and pulled their approval. We are currently going through a lawyer to fix this. But we should NOT have to be doing this!

Oh and every time I call them they put me on hold for 10 15 20 minutes and then I get ooops disconnected. In one day I was on the phone with them for 2.5 hours and they hung up on me 5 times. Today I called them they put me on hold for 25 minutes said they were transferring me to a surpervisor and ooops hung up on again. The day I was hung up on 5 times they said they were having phone problems....ya right whatever

I worked in medical claims filing for 11 plus years. United is the worst insurance company to deal with on the face of the earth. They are beyond "incompetent" and "unethical." They are liars and crooks. Fines are just slaps on the wrists to these giant companies. Someone with in UHC should go to jail (yes, TO JAIL) for the way they conduct business. I can't even begin to describe the issues I dealt with over the years with these criminals; It would seem like fiction it is so unbelievable. I am sure of one thing: Insurance companies are free to do anything they want because they own our lawmakers.