United Health Care / denial of claim

Review updated:

UHC's customer Service is non-existent. I received a bill from my former physician for services performed July 2007 through November 2007-yes THREE years ago. I spent 3+ hrs on the phone. I am sure UHC's main customer service site is in India. I was transferred back and forth at least 10 times. I was transferred to an automated survey twice, and once when I asked to speak with a manager, the customer service rep hung up on me. I finally spoke with somebody who seemed to be able to help me but they mentioned by records had been 'PURGED". I somehow doubt that. 'Archived' perhaps, but surely they are 'somewhere' in their system. My former physician has re-submitted the claims twice and each time UHC denies coverage: "Insurance Terminated". Well, DUH! No kidding I am not covered by UHC now, but for the entire year of 2007 I was covered. I have copies of the second submittal by the physician's billing department. Even the form states, "Per the website, this patient was covered 1/1/07 - 12/31/07. Please reprocess for additional payment." I wrote UHC a letter with supporting documentation. I did hear back but they state they have "No record of this claim." Then the form letter tells me to visit to view my claims and EOB's. Well I cannot access anything because I am now with Aetna .The stupid letter even tells me to "call customer care on the back of my member ID card..." and to mail a bunch of required info to, "The address on your member ID card."

They infuriate me so much. I am not paying another dime...other than postage to keep sending documentation that I was covered. How can they get away with this crap?!
I'm not to happy with the physician either. Why wait THREE damn years to refile a claim?? I do have one of the EOB's with a claim number stating that the physician was paid. At the very least I hope to be off the hook for $140 of the $345 they are demanding.

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  • Co
      Mar 12, 2012

    UHC should pay up - contact your state's Insurance Commissioner. If the doctor did submit the claim in a timely manner the first time UHC should be obligated to pay. I agree, your doctor's office bears a share of the blame here and you should resist paying him more than your would have owed under the terms of your insurance coverage at the time if they (UHC) end up refusing to pay at all. I handle my father's insurance paperwork and one of his specialists failed to file a claim for more than a year after the office visit. The insurance refused to pay anything on it at that point. It must have been one of the terms of being a provider in their 'family' that claims are submitted within a year of the service because we did get a notice that the company had refused to pay but the office never billed us.

    +1 Votes
  • Fe
      Mar 15, 2012

    Follow-up: After HOURS and HOURS of trying to talk to ANYBODY at UHC I finally got to talk to someone is the U.S.. They were extremely helpful. They said all my info had been archived. All of my previous calls to their Customer Support Center in India had somehow been diverted (every single time) to their PROVIDER line. Even when the CS reps would transfer me, my call would go to the Provider Line. When I would ask to speak with a supervisor, they would simply hang up on me. Anyways, the U.S. person I spoke with mail me copies of ALL of my EOB's. UHC had in fact paid the doctor for all of the claims they were trying to say they had not been reimbursed. I simply faxed these copies to the doctor's billing company and everything was dropped. I left a nasty review of the doctor on I wonder how many other patients ended up simply paying these bills to get them off their back/not have their credit history affected? Unfortunately, my company's insurance plan is back with UHC this year.

    0 Votes
  • Ka
      Jul 27, 2015

    I have varicose vein problems verified by Jefferson Radioolgy 6/30/15.
    Once submitted to United Health Care for treatment they denied the claim. This is not for cosmetic reasons it is for health reasons. Leg pain and swelling is a real, not just ugly. Can anyone help with this? I’m so upset by their ignorance and greed this should not be allowed. If this is denied what other problems can this cause that they should be held accountable for? Are they 100% confident this isn’t a necessary surgery?

    0 Votes

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