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.

I agree in part, Anon. United's ethics
may point to the bottom line but they are purposeful, not incompetent, in their actions. In response to a claim I filed against UNH I received years of hurdles, hoops and deliberate run-around. I got paid after my senator and OIG lawyers got after them.

The real winner$ were UNH bigwigs and whistlebolwers who sic'd OIG/DOJ on UNH. This even as other DOJ lawyers defended United's fraudulent MA acts against Medicare enrollees.

It is a funny old world.

we just acquired United healthcare group insurance through my husband's employer. We have the choice plus HSA account with a $6000 deductible for the two of us. It shows as $3000 deductible per person, but a family is $6000 and the policy syas we have to meet $6000 first before it starts pying. After reading the above comments I am braising myself for problems with htis insurance company. I worked for many years for a large doctor practice and can tell you about the insurance nightmares and also the incorrect billing problems at the doctor offices. With Aetna we could email customer service, so this way we had their response on black and white. I guess I will have to send any discrepancies by registered mail.

My family in Holland have know idea what I am talking about when it comes to all the EOB problems we encounter. Insurance companies in this country rule and that has got to change.

Uhc has consistantly denied my sons office visits claiming double coverage. This has been going on for over one year. Over 10 illegitimate denials. Every month I spend over an hour on the phone informing these people how wrong they are. They continue to say they have updated the system only to find out later that the note they put on my account was my wife did not have custody?!!! Not so!! Who do these people think they are? This last time, my request for resubmittal was denied, saying my son has double coverage again!!!!!! Every time we call to raise hell for the n'th time we are told lies. Flat out lies. Uhc has the most unprofessionsl call center reps and supervisors in the business. They hang up on you when their 8th grade brains figure out they are messing with someone who went to college. They figure 9 bucks per hour isn't enough to deal with a problem where the only answer is that they are ignorant. I also think they need to check on what kind of drugs they are putting in the bannas they feed the monkeys that process these claims Uhc is the worst insurance company in the business. I would rather sell used cars to cripples than be friends or neighbors to anyone that works for this corrupt and incompetant group of retards.

You said it.uhc is full of liars and thieves. The big shots at the top hire minorities with no education to answer the phones. Probably because they get some sort of affirmative action tax incentive to hire morons.

I have UHC and it is by far the worst insurance company I have ever dealt with! My son was born in May and has had his immunization shots over the last 6 months. I just received a bill from my the doctor's office stating I owe over $1000 for his check-ups and shots. I stated that my insurance covers the shots right?!?! WRONG! They cover $250 total for an entire year for his doc visits, then it is my responsibility to pay for the remainder. What a crock of crap! His first set of shots were $430...need I say more. He has to go back next month and get more. Something has got to be done - I am going into debt over keeping my family healthy while these slime balls in the ins industry continue to profit! I think a call into Michael Moore is in order. This is crap!

Found this page in a Google search after having problems with United Healthcare's Student Resources brand. I'm a grad student, and UHC has been delaying my claims for months while it requests my student status from my school. But when the school returns the form confirming that I am indeed a student, UHC claims to never have received it. The customer service rep that I spoke with accused my school of lying to me. I agree that I am being lied to, but not by my school.

As a provider I have become exhauseted over trying to get paid by United Healhcare. They never pay on a claim until you have truley exhausted all avenues and then they still do not. It takes anywhere from 6 months to a one year for payment. They most common denial is that the claim was not filed in a timely matter when it had. Why would anyone wait over three months to file a claim. All businesses need their monies. We continue to file appeals and call but can never get a person who will help. We just keep getting passed over from one department to another. This complany does not need to be in business. I have recently dropped being a provider for them. I do feel sorry for the patients that have UHC and strongly urge them to talk with their employer to change.

as a employee of uhc I can understand alot of people frustration on the processing of claims and them being denied. I am a CSR and no we are not underpaid paid and we are not morons. We are members as well with the company and have the same issues as you. So not only do we have to deal with thousands of people everyday about what is going on with their claims but we have to deal with ours as well. Unfortunatly we are the front line people that you have to speak with regarding any issues about your claims. To be honest we are not the people that process the claims. All we can do is look in the system and tell you whats wrong with the claims and why the claims adjusters are denying them.

I have a chance for BC/BS COBRA since I have left my recent employer. The new company would like me to go to UHC but, having read all of your comments, it seems foolish. Any experience out there with the short and long-term disability policies? They are part of the new package too.

I am so upset. I have UHC through my local government job, I have been jumping through all United hoops trying to get them to cover my lapband procedure. Called the customer service line for pre-auth and to find out exactly what would be required 3+ months ago and followed their instructions to a tee. Well, last week I heard from my Dr office that I was denied, United would not give a reason to the Dr's office. I called customer service and was told by the first rep that I was approved (?) but of course she had to transfer me to someone else. The dummy who couldn't even read half ( I didn't realize that "morbid" and "obesity" were so hard to read ) the words written in my file tells me that I was denied because I didn't have all the needed documentation they requested. WHAT? Just so you know, I have a provision in my policy that states that customer service reps are not responsible for any error's they make when dealing with us. We should be aware of the requirements. WELL IF THE UHC EMPLOYEES DON"T EVEN KNOW WHAT THEIR TALKING ABOUT AND UNITED CAN MAKE ANY CHANGES THEY WISH TO OUR POLICY HOW CAN WE STAY INFORMED!

When I try to call United Healthcare no one seems to know what is going on with claims and cannot hardly understand them with that accent. Cannot ever get an american on line. Cannot complain to anyone no number to call or even if I can talk to the President of UHC. its getting ridiculous

As a mental healthcare provider, my frustration continues to grow as UHC continues to buy out existing health insurance companies, which then further limits employer and employee options for healthcare. Since I've started my own private practice, it has been scary to see how many of my existing clients have had their insurance changed to UHC, often not even having had a choice in the matter, as their employers have made the choice for them! Providers are, more and more, having to face the dilemma of whether to get on or remain on UHC panels when UHC can just cut our fees in half, even if they are not paying anything on a claim (due to deductible, etc.). The fees for healthcare providers are not just for the provider's time and expertise. They also need to cover many expenses necessary to run a practice. If managed care had actually improved the rising cost of healthcare, I don't think most providers would even mind doing their part, but the cost of healthcare has risen more, and quicker than ever, since the advent of managed care. I have known a number of providers that temporarily held positions within behavioral health managed care departments, within several different insurance companies. None of them lasted long due to ethical dilemmas, as they recognized that there was no way that they even came close to covering their salaries with any care that they denied! In all of the years that I have been a mental healthcare provider, I have never had care denied because the care I provide is appropriate care! I don't know that UHC requires any treatment plans from providers any longer. Their current tactics are listed in many of the complaints above. Providers experience as many problems with UHC as patients/clients do. What was very disheartening and frightening to me was the response that a mental healthcare provider's office in Wisconsin received when they attempted to file a complaint with our state insurance commissioner's office. They were told that they were no longer taking complaints against UHC because they knew that UHC will just pay their fines and continue doing what they are doing. That tells me that UHC considers any fines as a less expensive way of doing business than providing fair payment to providers of appropriate healthcare. As long as our states and our country allow these kind of business practices, I fear that things will just continue to get worse for both providers and patients. At this point, I have one major question: when does a business become a monopoly because UHC certainly feels that way to me! If patients/clients have a choice about their healthcare insurance, I really hope that you are educating yourselves on all aspects of an organization, including how ethical they are in their business practices and what options they will have for providers. Although I am still a UHC provider at this point, I do that more out of a sense of ethical obligation to my patients (with having recently moved into my own private practice). If UHC continues to work in the ways that they do, I will have to leave their provider panel (as many other very competent and ethical providers already have). Maybe nothing will change until enough providers and patients refuse to be a part of their system. I don't have the answers to some major needed fixes in our healthcare system, but I know companies like UHC are not the answer. I don't know if the upcoming elections hold any possibility of real change in healthcare, but I do hope that we all do our part in researching candidates positions, voting, and holding politicians accountable.

Our 24 year-old daughter was hospitalized, in October, as the result of a stroke. She had left her employment in August and her UHC coverage was terminated effective August 31. She was in the process of obtaining health insurance coverage via COBRA when admitted to the hospital in October. Since she was not yet re-enrolled in UHC, the hospital and network providers could not/did not notify UHC of her admission/treatment. She was subsequently re-enrolled in UHC retroactive to September. UHC is denying her in network claims and hospitalization due to the failure of the network providers in notifying UHC of her admission/treatment. The non-network medical providers are being paid. How do we get UHC to pay the hospital and network providers?

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. Thanks girl I feel the exact same way you do. I'm currently on hold

Well, I've read almost all the comments and I think I may be the one opposite view here. I've been in medical billing for about 5 years and UHC is one of the better insurances out there. Now, they are the parent company of one of the worst insurances out there: Golden Rule, but we only have 1 or 2 patients with them, thank goodness. Seriously, I would love to see more patients with UHC -- below average to average denials, high reimbursement rates, speedy processing ... I rarely have problems with UHC. When I need to speak to a rep, the provider lines are pretty quick to go through. Now, I will say something for UHC that I would have to say for EVERY insurance company out there. The customer service reps are VERY ill-trained, not just the outsourced ones. There is no insurance company out there that I don't completely doubt everything the rep says to me. I always insist on something in writing from them to resolve any issue. I would encourage others to do that, too. It may not help too much (they'd rather say "I'm sorry" than pay a $10,000 claim, of course), but it's worth it.

United Health Care fails to enforce it's provider contracts and leaves the consumer to sort it out, which easily translates into consumer paying all bills out of pocket. What dream for UHC...how much longer are we going to take this from you? I tell you that I'm getting a movement for class action and since they are so crappy, I see that it wouldn't take much to scrounge up enough folks for it. Message here is don't mess with Americans. We'll get you.

Evidently this topic's thread has hit a raw nerve in both the patient and the provider community.
Here's a hint from someone who works at the other end - if you're have trouble getting authorizations or payments or eob's or even getting your phone calls answered by someone at your medical insurer who actually knows what he or she is doing - put together as detailed a summary of the problem as you can. Then WRITE a detailed letter to the Attorney General of your state - look up the AG's name on the internet (usually on your state's official website), or call 411 information and ask for the phone number of the Attorney General's office in (your state capital). Then write the letter addresses to the AG by name. Claim contract violations, insurance fraud, etc.
The AG's offices are great. They love stuff like this! Been there done that several times. No one ignores a letter from a state's Attorney General. They can shut you down, lock you up and throw away the key.
A letter from the AG will get your insurer's attention every time. Even monsters like Kaiser and UHC have been put into their place this way.
Howard