United Healthcare — denial of shingles vaccine
I have received yet another denial letter from UHC in response to my
They basically rehashed their denial stating it was just an "estimate" and referred me to the "Why Costs May Vary" section. I would understand
if they gave me a different amount for my Out of Pocket expense (say $100 & that in actuality it turned out to be $150), but they told me it was 100% covered for a 57 yr. old & that my Out of Pocket amount would be $0. Had they told me it was only a covered benefit for adults 60 yrs. of age or older or that it would have been 100% covered if I went to the pharmacy to get the shingles vaccine, I would have waited the 3 yrs. (now 2 yrs.) to get the vaccine or gone to my pharmacy where it would have truly been 100%
They gave me the wrong information & will not accept responsibility for their mistake. I was never given the external review from someone outside of UHC even though I had asked for an external review 4 times.
They have basically given me the runaround for 16 months in the hopes that I will give up. They hide behind jargon and twist it to their
advantage. Any average person being told "Good Job on Preventative Care" & that the shingles vaccine is 100% covered with $0 Out of Pocket expense would assume that it is a covered benefit and receive the vaccine.
Why would you think otherwise?
They are exhibiting "bad faith" all around. After all this, wouldn't it be a sign of integrity and responsibility just to pay the $210 instead
of spending probably hundreds of man hours and dollars to continue to deny the claim.
Every correspondence ends with "Your satisfaction is important to us." That is so very far from the truth. If that was true, they would have
paid this claim long ago & not ruin my credit by having the claim go to a collection agency.
Original complaint to BBB:
Prior to going to my doctor on 10-23-2014, I used the UHC estimator on their website to verify coverage for a shingles vaccine. I was told that for a 57 yr. old, it was 100% covered & "Good Job" on preventive care. That information was absolutely INCORRECT! I have been fighting with UHC for 16 months now. They state that it was only covered if I was 60 yrs. old (which is not what their estimator said). It stated that I would have $0 out of pocket cost. If they would have told me that it was only covered for 60 yr. olds, I would have waited the 3 yrs. to get the vaccine.
I appealed their decision that the bill was processed correctly. They kept changing whose responsibility the $210 was. I had asked for an external review 4 times & was never given this option. All the reviews were internal reviews done by UHC so what would you think the outcome would be, of course in their favor. I had informed UHC that my pharmacist told me, after the fact, that had I gotten the shingles vaccine from him, that it would have been covered. My 57 yr. old husband did get the vaccine from our pharmacist & it was indeed 100% covered. I asked why UHC didn't tell me this because I would most certainly have gone to the pharmacy to get the shot & saved myself all this grief.
I have 100 pages of documentation with UHC & about 50 phone calls & emails to them. On [protected], they sent me a letter stating "You have no responsibility for this claim. The provider cannot bill you for the difference between the contracted rate and the billed charges". I forwarded this information to the provider & thought the case was finally settled.
Imagine my horror when I received a call from a collection agency stating that I owed the $210 & that UHC reprocessed the claim again & now I was responsible for the bill. UHC didn't even have the decency to contact me to let me know. I had to find out from a collection agency. The agency informed me that they would report me to the Credit Bureau & ruin my credit if I did not pay the $210 by 2-14-16. My credit score is 840 & I have never had an issue with bad debt prior to this nightmare.
I was at my wit's end & sent a letter to the CEO of UHC. He forwarded the letter to their Consumer Affairs dept. I just received a letter from them again stating they would not pay. In the letter it states "You may wish to check with your pharmacy regarding whether they will reimburse you for the charges." Because I have been fighting this for 16 months, we don't even have the same pharmacy provider anymore. Like I said, had they told me to go to my pharmacy to get the vaccine, I would absolutely have done that.
I have been given the runaround by UHC & they will not accept responsibility for their error. The letter I received from their Consumer Affairs dept. is a joke. She states "If you have a question on what your plan will cover, call your medical claims administrator's customer service dept."
I have had many, many conversations with "customer service" & they have been absolutely no help whatsoever. They tout their estimator as a great tool to be used by subscribers. How great is it when it gives INCORRECT information. Her statement to call customer service after using the estimator basically tells me that they have no faith in the accuracy of their estimator. How do you run a business like that? I feel I did everything I was supposed to prior to getting the shingles vaccine & I relied on the information I was given by UHC, which turned out to be false. Isn't it reasonable to expect that the information you are given on the company's website is accurate & shouldn't they stand by that information?
"Under the law of most jurisdictions in the U.S., insurance companies owe a duty of good faith and fair dealing to the persons they insure". I do not believe UHC is meeting that obligation. They have basically given me the runaround time & time again. They are exhibiting "bad faith" all around. I do not want my credit ruined because of this. I have worked in the healthcare field for 33 yrs. & am very knowledgeable about insurance. I give patients estimates as part of my job & if I feel the estimate is not accurate, I will not give the patient the estimate. I do that rather than give them wrong information. Unfortunately I cannot go to the Office of the Commissioner of Insurance for our state because this is a self-funded plan.
I have filed a complaint with the Better Business Bureau. I find it interesting that UHC's score is "D-" according to the BBB & rightfully so. You cannot believe how frustrating this has been dealing with UHC. If I had a choice, I would never choose UHC as my health insurance carrier & would never recommend it to anyone.
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