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United Healthcare / denial of claims

1 TX, United States Review updated:

United has denied numerous claims based on a 3rd party reviewing the claims. However, they refuse to give the reason for denial which prevents the doctor's office from correcting the problem or from appealing. That is against the Provider Agreement the insurance company signed. The 3rd party, meanwhile, are paid a percentage of claims they find a reason to deny. The doctor cannot successfully appeal and continues to file the claims "incorrectly" resulting in even more denials. Someone needs to file a class action lawsuit against United.

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Comments

  • Pa
      6th of Apr, 2012
    0 Votes

    Ever since UnitedHealthcare Community Plan took over Evercare of Texas my once effective and progressive health care has come to an abrupt and unsettling halt. I have always strived to maintain compliance within the client guidelines of my plan and my position has not changed. I call my service coordinator and ask what information needs to be sent for a pre-authorization and where to send it. I provide my primary care physician the information United "tells me" they require. From that point it becomes a nightmare.

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