United Healthcare to pay $12M to settle complaints

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

I have UHC PPO with out-of-network benefits. I had a major surgery with a highly recommended physician. I verified with UHC that I had a max $3,000.00 out-of-network benefit of charges that were considered Usual and Customary. I went to Rush University Medical Center in Chicago for the surgery. The physician's billed were negotiated under the Shared Cost benefit option. The facility charge was not negotiated . The facilty billed $16052.51 UHC claims that $12,151.88 was
over U & C only $3,900.63 was allowed and I owe $13,712.13. I requested and itemized bill from Rush, I appealed with United Healthcare to review charges. Appeal was denied and orginal decision was up held. I feel i was mislead by UHC and not warned that such a large amount could be disallowed. After I appealed United Healthcare stated that had incorrectly paid too much money on other claims relating to the surgery and requested refunds from the providers. Now I am afraid to request anymore reviews because I may end owing much more money as they find errors in their favor. PLEASE INCLUDE ME IN ON ANY CLASS ACTION LAWSUIT. SLOW CLAIM PAYMENTS/POOR COMMUNICATION/ UNFAIR BUSINESS PRACTICES.

Anyone having information on a class action law suit against UHC, please contact me, any and all medical bills were denied by UHC, for 2 yrs while I had coverage with them, this included annual GYN testing. Every time I had a visit with a doctor, I would have to call them a week later to find out why they denied the claim. Finally it has me in a position where I now have collection companies calling me on the bills UHC would not pay, that I could not pay this is why I had insurance. UHC wears you down
in hopes you will give up this is what I did, however after reading how so many others have the same issues I am ready to do something. The awful thing is the company I am with is now considering changing our insurance from BCBS to UHC, God help us, as I see it this a very important benefit and was one of the first things I asked about who is your insurance carrier, had they said intially UHC, I would have passed up the job, this is how much UHC has distressed me. Please anyone email me with any info you may have, it would be greatly appreciated.

Secure Horizons/UHC is not incompetent...they are highly unethical. There practices of non-payment, denials, and giving people the run around are there way of increasing profits. Their goal...hope people get so frustrated they give up and pay.
My Mother has Alzheimer's and I have "Power of Attorney. I have repeatedly tried to get her a Dr. & they refuse to help me because they claim they have no POA on file. I have numerous fax confirmations and and recorded calls and they still deny they have this information. When I ask to speak with someone that can help I am told they have no way to contact the department to assist me with getting a POA on file and therefore, without this document, they cannot allow me to take her to a Dr. that can help her. My Mother has lost a tremendous amount of weight, does not have adequate medication, has gotten lost repeatly, and has severe anxiety. I cannot get her the help she needs through Secure Horizons. I will have to absorb the expense on my own, however, I am on a mission to help all of those elderly who cannot fight for themselves or who are not mentally capable of figuring out this system. If anyone knows of a dementia patient who has recieved similar treatment, please contact me. I am going to compile a list of complaints, post in every major paper, and contact 60 minutes. Maybe together we can make a difference!

I am so glad in a way to see this forum. 2007 was the most frustrating year of my life due to UHC. I paid thousands of dollars for speech therapy for my son with autism, being told that we would get reimbursed 80 percent since we were using a non-network provider (we had a Plus plan). The first month was done correctly, but everything after that claimed that the provider was in network. The provider called many times on my behalf to say they were not in network, and in fact, show us a copy of the contract you claim we have with you. No one could, but kept insisting there was one. So I lost tons of money and could never get anyone to help.

To Ruthy H, who made a comment earlier -- You believe UHC is one of the better companies, correct? I am not trying to appear arrogant or remise, however, let me guess your situation -- either you work for a family practitioner (not a specialist) or you've been in billing for a year or less. I think when we post here, we should all try to qualify ourselves a little bit better. Again, I am an insurance agent who has been in this business for more than 25 years. And, yes, I've dealt w/ just about all of them. These people on this forum do have valid complaints. I have seen these instances for myself. What I have seen on my end, with my own clients, is that UHC tends to mess around w/ claims less than $5000 (and guess what, most attorneys will not take on this little bit of money and they know that). For the most part, the problem tends to deal w/ things they feel they can dispute, ie, where you had the procedure, who ok'd it, why it was ok'd, etc. It really can go on and on. You will generally not see this type of a problem at the GP or Family Practitioner level. From what I have seen, this is happening mainly on the specialist, or specialty testing/procedure levels.

Sorry to disagree w/ you Ruthy -- but, man, people are really getting screwed over here!!