United HealthCare Services — appeal denial, dos aug. 10, 2015
DOS, Aug. 10, 2015
UHC Member ID at time of service, [protected], group # 717191
- severe injury to thumb
- emergency surgery required in Phoenix, 90 minutes from my home
- the only micro-surgeon available, Dr. Jonathan Yang (out of network)
- claim denied, UHC
- appeal filed by Arizona Center for Hand Surgery on my behalf
- appeal denied
- appeal filed by me, Greg Vermillion, the patient
- appeal denied
- UHC Rep told me it was my responsibility to work with my PCP to obtain an in-network surgeon or get prior authorization from UHC for an out of network surgeon. I'm in the back of an ambulance, drugged on morphine, on my way to Phoenix to hopefully save my thumb. This was NOT possible!
- I called one day to check the status of my appeal and was told there were no records showing I had ever filed an appeal even though I have the denial to that appeal. Was told to file another one. I did just that. Got a letter from UHC telling me the deadline to file an appeal had passed. Well, of course it had.
- Overall, UHC has been there for me. But in an emergency, I got the run around and I had to pay an agreed upon amount of $6, 300 to the surgeon for excellent services provided, far less than his original amount of $31, 465. Why? Because I didn't have the ambulance driver pull over while I called my PCP and made some more calls and worked out a plan to have an "in network" provider do the emergency surgery or get prior authorization from UHC for an out of network provider to do the surgery. Meanwhile my thumb was already turning blue and dying. But Dr. Jonathan Yang saved my thumb. The assisting surgeon, also "out of network" was paid by UHC for his emergency services. But not Dr. Yang. Why?
- I am still paying, to this day, on the credit card I charged the $6, 300 which already had a balance on it before I charged anymore.
- Wish I could trust UHC in an emergency situation to look out for me, but they will only look out for themselves and make absolutely impossible requests and requirements to be met to get out of paying claims.
- UHC has been good to me for my overall care. But not in an emergency.
Submitted by Greg Vermillion, 4780 E. Kristen Dr., Prescott, AZ 86301
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