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United Healthcare / medical claims

Dallas, TX, United States Review updated:

I have a son who receives "covered" Occupational Therapy and Speech Therapy weekly, and for the last entire year, United Healthcare has HABITUALLY processed the claims incorrectly and/or unbelievably slowly.

The 1-800 agents are rude, incompetent, and the "claims appeal" process is a joke. I literally call them on a weekly basis and get no clear direction on how they want the bills to come/how I should file. For my company, we only have a year to appeal claims and United just runs the clock out on you.

Additionally, the pharmacy coverage is laughable. Btw, I work for a mid-size company (approx 26k employees).

Jj
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Comments

  • Se
      Jan 02, 2010

    My husbands company just changed the insurance company to united health care. We were told by the UHC representitive that my sons speech therapies will not be covered. We have been paying them out of our pockets. Any advice?

    0 Votes
  • Ga
      Jan 15, 2010

    WE ARE A 7 DOCTOR PRACTICE WITH MANY UHC PATIENTS. THE REPS ON THE 1-800 LINE ARE ALL FOREIGNERS WHO BARELY SPEAK ENGLISH. THEY DO NOT UNDERSTAND YOUR PROBLEM AND I AM CALLING EVERY 2 WEEKS TO GET MY CLAIM REPROCESSED. THEY ARE RUDE AND EITHER HANG UP ON YOU OR LEAVE YOU ON HOLD INDEFINITELY. I JUST FILED A FORMAL COMPLAINT WITH THE NJ DEPT OF BANKING AND INSURANCE. I NEED EVERYONE TO COMPLAIN SO THAT WE CAN GET SOMETHING RESOLVED. OUTSOURCING CLAIMS DOESN'T WORK!!!

    0 Votes
  • Wr
      Feb 17, 2010

    I have the same problem...We are an anesthesia group in Texas that is NOT in network with UHC. When an insurance company pays out of network we will call them and most every other insurance companywill reprocess our claims in-network (RAPS) if the facility and/or surgeon is in their network because the patient has no choice as to sho to use for anesthesia. With UHC, I always get a foreign person that I can hardly understand and they cannot understand what I am saying to them. Sometimes they will tell me the claim will be reprocessed and they give me a reference number and say to allow 15 busniess days...I'll call back in about a month and I am told it was not processed right and they will send it back through to be reprocessed and tell me to use the same reference number when I call back to check status. I have to keep doing this over and over on the same patients. Every once in a while I wil get an American and when I do...I am so thankful. WHY DOES UNITED HEALTHCARE PUT THEIR COSTOMERS THROUGH THIS? I have asked an American rep before why does a foreign person always answer and I was told they were trying to change things to where they are getting rid of the people in India. I just want to hang up when those people answer the phone and then they tell me their name...it's always an American name like...John, Sue, Jack...etc... we know that's not their real name...I am just so thankful I don't have United Healthcare as my Insurance and feel sorry for all those who do. They waste so much of my time!!!

    0 Votes
  • An
      Jul 26, 2017

    @wrye1226 I have the same issue with UHC!
    I briefly explain what services we render and we are out of network, and it like I'm talking to little kids because they don't understand what RAPS is!!! But I would like to ask you, who and how are out of network pricing based when the RAPS clause apply to the claim?

    0 Votes
  • Ag
      Sep 03, 2010

    I totally agree.. the claims and appeals process is a complete joke. I have been denied three times for emergency surgery that already took place when we were out of town and "out of network." I have gotten so much conflicting information from UHC, wasting hours and hours on the phone. And yet, they denied the claim again today.

    0 Votes
  • Ho
      Sep 12, 2010

    wrye1226:

    What an idiot. Where did you take the discussion to make a tirade of an Indian call center? Jealous of your smarter Indian physician counterparts?

    -1 Votes
  • De
      Nov 30, 2010

    I thought my old Oxford coverage was bad because they kept upping the cost of pharmacy copays but I paid out of pocket for an emergency surgery which is covered by UHC for out of network doctors and I have had to send the claims form in twice and the claim is still "in process" three month from the operation. I lucked out with getting native English speakers but they basically had no idea what they were talking about. One operator told me that UHC would notify my doctor via snail mail to resubmit a claim form with x-ray. Point 1, UHC never notified my doctor and thank god I called them to make sure or the resubmission would never have occurred. Point 2, why would anyone send a letter instead of email unless they wanted to hold on to their cash flow as long as possible. Insurance companies suck and if my company did not automatically enroll us, I would rather risk paying for the sum total of my medical bills than give a single penny to these vultures of society.

    0 Votes
  • Ga
      Mar 16, 2016

    Medical plan # 911-87723-04
    Group # 902732
    Medical ID# 908895786
    There data base is so inaccurate that it is gross negligence on United Healthcare part. MY primary care physician has been trying for several days to get me an appointment but she has not found a single doctor listed in there data bast that is #1 open and actually in business. #3 someone will answer the phone. #3 will take my insurance. I am left in pain because United Health care is taking my money and not providing the services I am paying for.

    0 Votes

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