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United Healthcare / denial of coverage

1 Sammamish, WA, United States Review updated:
Contact information:

I have a serious problem with my healthcare coverage. I do not think we are being handled properly. We discussed the matter with the healthcare insurance company’s 1-800 center today but accomplished nothing. My company switched to United Healthcare in April of this year.

My wife, has been experiencing severe pains in her shoulder. In April I paid ~ $ 600 (my out of pocket) for an MRI... as a result of the MRI, our physician says she needs surgery to fix the problem. My wife was scheduled to have surgery on June 17th. Today, my wife’s surgeon called and said that United Healthcare has denied our coverage. United claims the problem is a “pre-existing” condition and they will not authorize surgery for over a year.

Does this mean my wife has to go eleven more months of pain and discomfort ? for a condition that needs correcting... that is absurd?

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Comments

  • Tb
      22nd of Jul, 2008
    0 Votes

    they cannot deny your wife coverage. you would have to have a break of health ins for 63 days or more since you had coverage prior to your company's change they cannot refuse to pay using pre existing clause, write to your state ins commissioner. tell him your story ceo of uhc will have to answer him in 14 days as to why they are denying you. chances are they will quickly change their tune.

  • Ni
      8th of Aug, 2008
    +1 Votes

    It is not UHC that is stating they will not autorize the surgery, it is your doctor because there is a Pre Exisiting clause on your medical plan. Your doctor can actually fill out a form and send back to UHC to confirm that they have never treated her for this condition before. If that is confirmed, then UHC would pay for the claim. If you had prior coverage, you can send UHC proof of that and if it satisfies the pre exisiting clause outlined in your plan that was CHOSEN by your employer (employers can choose plans that do NOT have a pre existing clause) then your files would be updated stating that there is no pre existing that applies.

  • Wr
      23rd of May, 2009
    0 Votes

    United Healthcare is denying my visit to an orthopedic for a shoulder injury.

    - I had insurance with Blue Cross until Nov-2008.
    - I took a new job and started coverage with United in Nov-2008.
    - I injured my shoulder in Feb-2009 and visited the doctor in Mar-2009.
    - I was told United denied my claim because it was a pre-existing condition.
    - The doctor's office told me they did not tell the United that it was a pre-existing condition. It appears that United marked it as a pre-existing condition because of the type of injury it was - Rotator cuff.
    - I supplied proof of my previous coverage to United.
    - They have since sent my doctor a letter saying they are denying my coverage.

    Any advice on my next steps would be appreciated. The bill is only a few hundred dollars but I want to fight this on principal.

  • Wr
      23rd of May, 2009
    0 Votes

    principle!

  • Fa
      17th of Jun, 2009
    0 Votes

    1. You can appeal the decision. Everyone has a right to appeal. Get your doctor to write a letter to include in your appeal.

    2. Visit this website to get info on how to write an effective appeal letter: http://www.advocacyforpatients.org

    3. If you need help going to bat with your insurance company contact the people at that website - and they should help you free of charge.

    4. Contact your state's insurance regulatory agency, which should be listed in your phone books' blue pages. Your doctor's office should know how to get in touch with them. Send them all the info you included in the appeal.

    5. Contact your local Better Business Bureau office by letter explaining this situation. Include your appeal letter.

    6. Contact your state's attorney general's office. Send them the appeal letter.

    7. Important... because health care insurance reform is a hot federal issue right now, you should contact your federal representatives (senators/congressmen) and tell them about this. They are working on federal legislation right now, and hearing from people who've been screwed and defrauded by insurance companies who cheat people by denying claims for nebulous reasons will help them to better understand what we have to go through at the mercy of these greedy insurance companies.

    This is fairly common... Insurance companies will use any lies or weak arguments to get out of paying claims. They'll lie and say a provider is no longer in their network... They'll say that something was pre-existing when it wasn't... They'll say a treatment, visit or procedure was not pre-authorized, when they didn't tell the provider of any such requirement when they called to verify coverage - or if pre-authorization was obtained, the insurer will lie and say it wasn't... and there is no limit to the other lies and inconsistencies they'll grasp for in an effort to screw policyholders over.

    Please fight this. It may just be a few hundred dollars to you, but they're getting away with doing this to millions of people. If just 50% of policyholders give up and move on without taking action, just think of the money they're making, hand over fist, through BAD FAITH PRACTICES. This is ill-gotten gain; fraud.

    Please pursue this with the agencies that I listed above and be sure to keep a copy of any correspondence you send, keep a copy of anything you receive - and document the dates/times of all phone conversations - along with the employee name. If you can, record the conversations. You'd be surprised how handy this can be! They'll tell you one thing during one call, and then tell you something totally different the next conversation! They'll lie and say that a certain conversation never took place.

    It's a shame that we have to push for our rights, but the fact is - we do. They profit from people just giving up and not pursuing their right to appeal. You can continue appealing indefinitely; just keep copies of everything you send and don't rely on just phone conversations. Also, send everything either by U.S. Certified Mail Return Receipt or overnight mail so you'll have a signature confirmation of delivery.

    Fight it! Don't give up!

  • Ju
      1st of Sep, 2009
    0 Votes

    I was actually told I had to travel 125 miles to have an MRI for lower back--it was in the winter and over the mountain pass. After they sent me fro Bend to Eugene when the billing came in they tried to deny it. They will do anything possible to deny a claim so they don't have to pay for 4 to 6 months. They have never paid my chiropractor even as an out of network and they claim I have Medicare coverage which I only have hospital part A and they treat the doctors and clinics under the same guidelines.

  • Ds
      5th of Jan, 2011
    +1 Votes

    My Father is in a skilled nursing home with a terminal disease. He has coverage under UHC through his pension plan which is suppose to cover this. He also has extended coverage with them. They have refused to pay! Each month it is a different excuse of additional paperwork they require. We have been paying out of pocket for the past 6 months. What can we do about this?

  • De
      22nd of Feb, 2013
    0 Votes

    I have been having headaches and neck and back pain and right arm numbness constantly for the past three months. I live in Oklahoma and have Choice Plus Network. I was referred to the neurologist by my PCP who had me do an MRI without contrast. The MRI showed I have either a Nerve Sheath Tumor or a Perineural Cyst on the nerve in my spinal cord in my neck and some bone marrow changes on my spine. It recommends follow up with and MRI with contrast, but insurance has denied it. My doctor appealed and it was denied again. I called and they said they never got any information. I called my doctor's office and she gave me the dates she sent the reports and who she talked to and the reference number. I called UHC back and after a long time on hold they finally told me it was denied because it didn't show I had been on pain medicine for at least 6 weeks and/or physical therapy, weakness or loss of function or plans for surgery. I have been taking over the counter pain medicine and most days I am having to lay down. The neurologist said there was a possibility it could be malignant. Now I am waiting to consult with a neurosurgeon who will then try to request the MRI again!! I have two young children and take very good care of myself and my family and don't want to wait until it is worse!

  • Wa
      11th of Jan, 2016
    0 Votes

    UHC changed my plan. When I went to get my Rx was told it wasn't on the plan now. Had to have doctor file an appeal., Which I did. Although talking to insurance companies is not the doctors job. He wrote the Rx that is what I should get. It shouldn't be the insurance companies decision to decide what medication a patient needs. I am so annoyed and frustrated. with United Health Care. I don't know what they expect a patient to do while they are deciding if I need the medication,

  • Sp
      26th of May, 2016
    0 Votes

    My Medicare Advantage Insurance is supposed to provide vision coverage. I attended a meeting at the clinic (Sansum) around which the plan was organized. I was told that Sansum Clinic was the ONLY provider of vision coverage for the plan. When /i went to Sansum for a vision checkup, I was told after the visit that they would not accept my insurance and billed me for the entire amount. United Health Care told me "Tough luck, you aren't covered"

  • We
      18th of Apr, 2018
    +1 Votes

    https://www.gofundme.com/fighting-the-bulies-at-uhc?sharetype=teams&member=87882&rcid=r01-152407620391-f82b32f22b814606&pc=ot_co_campmgmt_w

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