November 25, 2014

True Tales from the Health Insurance Wars - UHC

One thing about the health insurance business environment is that it's pretty contentious throughout. It seems to be the nature of the beast and holds true for both customers and employees. This section highlights their "observations" culled from from various internet forums. We'll take it company by company. First up, that perennial scofflaw, United HealthCare. 
If you need a new hobby, please consider the joy of insurance claim phone calls! I have two obviously fraudulent claims with UHC. One: I want them to pay me back for my eye exam, which is covered at 100%. Two: I want them to help pay for Nea’s speech therapy. I know, I know. Crazy talk.

After, lo, these many painful hours of dealing with UHC, I’m ready to share my knowledge.

When calling, after you enter your subscriber number and date of birth, say “representative” if you want to talk to a person. When you are on hold, if you say "shut up" the recording will stop telling you about their worthless web site. You may need to say it a few times. Forcefully.

If the person on the phone can’t help you, ask for a “rapid resolution specialist.” They can fix things the Tier One people can’t. And they won’t tell you the magic phrase (“rapid resolution specialist”) until you’ve wasted hours of your life. If they don't want to pass you on, just keep using the magic phrase: "I'd like to speak with a rapid resolution specialist.”

If you have an ongoing complicated case, ask to be assigned a “care coordination case number.” It probably won’t help, but it’s worth a shot. 

If you want them to cover an out-of-network provider at the in-network level, you need a "gap exception" -- another magic phrase they won't tell you about. If you are lucky enough to get a gap exception, make sure you take the reference number to your provider! UHC won't do that for you, so you'll continue to be billed at the out-of-network rate.

When faxing, don’t bother. You can fax and fax and fax, even “to the attention of” someone’s name, and they will claim it didn’t arrive or is illegible.

And my number one tip? Switch to another insurance company as soon as your company lets you. Thank god my long nightmare is nearly over. 
 by Bluestem 
Absolute TORTURE. For months, we have simply been paying our bills on time and we have been put through insane harassment from the "customer service" department. They call on a daily basis, claiming that for one reason or another, we are not covered for health insurance. My poor father is wasting precious hours of life, and many many precious days of life simply trying to fix their mistakes. They treat us LIKE CRIMINALS because of their own mistakes, and each time something comes up, a minimum of 4 hours are spent on the phone, explaining the most simple things. They claimed our primary physician wasn't in the network, and my dad had to explain 6 times that he was, spell the doctor's name, give them his address, phone number, middle name, and it wasn't until he said "look on page 228 of your network book," that they understood. The hell this company has put my family through is inexcusable, and we are honestly considering suing them for harassment. I am SICK over the number of days spent fixing this company's mistakes, and being treated like DIRT the whole time. 

Every day, my dad has migraines, only because of the stress he has been put through over this insurance bull. He throws up, his blood pressure skyrockets, and overall, I can confidently say trying to get health insurance has taken YEARS off his life. Dealing with health insurance companies is RUINING HIS HEALTH

I can't express the rage I feel towards his company for LITERALLY RUINING their lives. My dad attempted suicide months ago after YET ANOTHER insurance mistake, and it threw him over the edge. Still, they pester him daily, and I sit at home worrying the same thing will happen again. 

Do yourself a favor and move to Canada. It's not worth the turmoil. 
by Carolyn 

As a retired insurance company attorney I would suggest that anyone jerked around or wrongfully denied coverage contact a good attorney. This is known as "bad faith" in the industry and it scares insurance companies to death. My experience with this company is absolutely terrible.
This insurance sucks big time. You are given incorrect information. talked down to by surly reps and once I was transferred to a recording stating"you have been transferred to a non-working extension" this after I selected prompt 1. One person told me to send my scripts to San Diego and another told me to send them to Kansas where Dorothy and Toto will personally fill my order. You would do better sending your precriptions to the Planet Zodar and send them to the attention of Glork.  
An even better alternative would be to take a cyanide capsule and then douse yourself with five gallons of Gasoline and light yourself on fire. Two days of calls and I still do not If they received my prescription scripts. The entire management of United Healthcare should be fired and then forced to work in the bilges of a Turkish tramp steamer. AARP who administers this plan could give a damn less about their members. Sign up for this insurance at your own peril. You have been warned. After talking with these cretins I will probably have to get a script for Valium and some form of mood stabilizers.
by Mack

To United Health Care, CEO, BOARD MEMBERS, EXECUTIVE STAFF and you loving management personnel. Listen up man !!! 
I won't waste my breath with my true story of what you bastards did to me. However, Washington, The FBI and all law enforcement who don't have the balls to come after you need to realize the money you pay for lobbyist, for a Senators or Congressman's election will end as that money your spending is our money your customers. Oh you don't remember us as your too busy denying our claims each and everyone of us. I challenge Law Enforcement if you have the Balls to bring down this filth as they are tearing apart good families and stealing from us good, hard working people.

Listen up everyone write THE FBI, YOUR CONGRESSMAN, YOUr SENATOR and lets get criminal action going. Write Barbra Walters ABC NEWS and any news organization you can who will listen. Let them see each web sites with complaints logged on line. Lets get these jerks. Who the hell do they think they are messing with. One last thing remember we are the people and we the people control United Healths Destiny. Yes I seen the abusive tactics your corp does each and everyday as I'm a victim. As I ponder how to legally get you back legally with law enforcement, attorneys and the great people of America I 'm sitting her thinking how wonderful it is going to be getting you put in jail. I have one promise to you Mr. CEO I'm coming for your ass you scum bag. I'm not the least bit surprised about you ways after dealing with your company at many levels to see a fraudulent corporation with cover ups, lies and stealing. 

May God Please you souls.
Happy New Year, 
Who Loves You Baby?  
by Suffered To Much 

In 2008 I worked for United Health Care in Duluth, Minnesota as a claims processor. I did well for five of the months I worked there,
Then in the 6th month my supervisor tried to have me written up for filing a claim incorrectly but the training documents we had been given completely justified why I had denied the claim, and I provided the proof to her. Instead they just changed the particular rules in question for everyone else and still wanted me to take the write up.
Another coworker or two made the same mistake and they were not being written up. To top it off, we weren't supposed to be written up until we had hit 180 days of employment and this was before that 180 days were over. I argued the matter and talked to other coworkers about the issue, and they agreed with me. Unfortunately one of them couldn't keep their mouth shut. More on that later.
I then e-mailed the manager because my supervisor had pulled me into a room and intimidated me by saying I was being insuboardenant and she wanted me to take a 2nd write up for the insubordination and one for the original mistake. Once I emailed the manager instead of talking to both the supervisor and I the manager and supervisor pulled me into a private room and intimidated me and wouldn't let me speak.
They basically said this might not be the right job for me, and I shouldn't have asked the other coworkers for their input and I should've basically just taken the write up and the "fall" for their faulty training. After the meeting with the supervisor and the manager I went back to my desk to print out emails with all the proof of everything that was going on so I could go to the production manager the next day and prove my case,
Instead somehow the manager was spying on my computer and sent me an e-mail telling me she had went to the printer and gotten the emails and I'm not allowed to have copies. After this, I quit because I was scared and humiliated.
I tried to file a complaint with the Human Resources company for UNITED HEALTH CARE but they wouldn't even investigate. They told me to go to work and take the write up for the mistake that was BECAUSE of faulty training. Alas, I didn't. I just quit. Then to to top it off, over 2 years later, they have me on a no rehire list for the entire company. What kind of company would treat an employee this way when they were the ones who made the error during training and not me?

by HatesUHCalot 
Very telling story on UHC and our country's healthcare problems in general. I work for UHC so I am familiar with procedure codes, terminology and benefit structure. I needed emergency dental work but was uncomfortable with my interpretation of my plan. I go to dentist and get a treatment plan (all the procedure codes they will bill my insurance for my services). I call up my office and fax over my treatment plan so I know what my patient responsibility will be and how much they will pay before agreeing to my procedure.
I am told I will owe $1900 by not one, but two different reps. I use the online "treatment cost calculator which says I will owe $1900, not a bad deal in my opinion. I go through with the procedure and I get a bill saying I owe $5k. I appeal it and they tell me the information online, from the reps and from my certificate of coverage may be wrong and that there is nothing I can do about it.
As an employee of UHC, I get emails and flyers all day on how we are so great and the best insurance in the world but from an insider perspective I know better: They have incompetent employees train unqualified new hires in both the claim processing and customer service dept. Therefore, you call for an answer, you get the wrong one,. Then when your claim is billed, the processor pays it wrong and your stuck with the bill.
Personally, I am out $2100 and a whole lot of stress because of my own employers idiocracy. They dont pay well, they offer terrible insurance to their own employees which I find to be ironic, but the good news is, because I work on the inside, I can scam that lost $2100 back to my own pocket but will have to violate HIPPA and other federal mandates to do so. But I learned from my own employer that when it comes to dollars and cents, it only makes sense to care about yourself. This is a perfect examply of our nation's healthcare problems as a whole - people have no clue how much they will be liable for until months after they agree to services.
If only this industry worked like others where you know what you are buying and how much it is prior, and if you're dissatisfied with the product/service, you get your money back. Imagine if you had to sign papers to buy a car but weren't told the price until after its yours. Or imagine if the nutrional facts and "sell by" date at the grocery store were incorrect. Healthcare in our country is the only industry in the world that is like this.
The saddest part of my personal story is that I would have saved $1500 if I bought a dental discount card for $20/year as opposed to the $20 I pay bi-weekly. For future purposes, my best advice to everybody with UHC health/dental is to get from your doctor exactly the procedure codes/dates of service/diagnoses they would bill your insurance for, then print out a HICF form and send in a fake claim yourself. It will take about a month to get it back, but it's the only way to know exactly what they will cover.
Something else to keep in mind ; If you go to an out of network provider, the doctor doesn't get an EOB, just you. This opens the door for fraudulent billing and getting big checks sent to you directly. You can continue to send the same bogus claim in just stamp "corrected" on it and write that you went to another doctor on the same day of service for a repeat procedure. If your a provider, I hate you too! But you can do the same and get paid multiple times for the same claim depleting our country's healthcare funds. But hey, in this industry it's every man/woman for themselves.

by UHC Sucks 


Melody Townsel's health insurance horror story started when her daughter was denied coverage for her hospital stay because the aspirin she accidentally swallowed was deemed a "suicide attempt" by her insurance company..

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