United Healthcare / benefits not being paid out per agreement

I was a gastric sleeve surgery patient at johns hopkins bayview. I was enrolled and completed the nutritional program by november 2015. I switched my coverage from united healthcare with enterprise to united healthcare with nestle through my husband's employer since enterprise didn't elect the bariatric coverage on the policy. I was told by my case worker that if a transfer of care was approved, I wouldn't have to switch to one of the three hospitals listed as a center of excellence. The transfer of care was approved so they submitted the approval for my surgery with all the required documentation. I received 2 approval letters in the mail stating my surgery was going to be covered from united healthcare. I called my care worker, shaunna, and was told it would fall under the same bariatric program at 100% coverage minus my $750 deductible. She recommended that I call claims to verify, which I did and spoke to 2 different reps. They verified that the $750 deductible would apply given the approval of the surgery. I had the surgery april 22nd and about 3 months later, I get 2 bills. One was for almost $300 and the other for almost $2700. I called and spoke to a couple different reps again and was told it wasn't processed correctly and that payment would be processed by one rep and that an appeal would be filed by another rep. No one followed up, my care worker shaunna didn't return my messages, and no one could give me any answers. I finally got shaunna on the phone 11/2 and was told she needed to look into it and call me back. She called back today at 4:30p telling me that it was processed like an in-house claim and not my bariatric resource program, meaning they are covering only 80% and i'm responsible for 20%. I told her that wasn't the information everyone had been giving me and was why the transfer of care was put through, so the surgery would qualify under the bariatric program. She told me she couldn't adjust the claim and would have a supervisor call me back. When I asked their name, I was told there are two and she wasn't sure which one would want to speak with me. When I asked who would have the authority to adjust acclaim, I was told she didn't know and had no more answers for me. I am beyond pissed off and frustrated. No one can give me any answers or help me at all. I feel like I need to contact a local senator and possibly bbb. I have been lied to, deceived, tricked, and now i'm being given the runaround.

Nov 03, 2016

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