This is not a frivolous complaint but a very serious one, written out of frustration and anger. I have literarily spent hours on the phone with United Healthcare AARP Medicare RX representatives, simply trying to obtain what is due to me per the prescription plan I have paid premiums on for years. The problem is relatively simple. But the lack of clear communication, proper customer service, and basic record keeping in the part of this company is nothing less than shocking. I am convinced now that my specific problem will never be addressed with competence, let alone solved. This will literally cost me hundreds of dollars and immeasurable stress.
As stated, the problem itself is fairly simple. I needed to get a medicine that I have taken for more than 30 years. Due to manufacturing problems, it was unavailable in the U.S. for many months, so I obtained it through a pharmacy in Europe. Now it is available in the U.S. again but only through two distributors. So I had to find a pharmacy that could guarantee a supply because they worked with those distributors. However, when I picked up the meds, my coverage through United Healthcare was denied. The total for the prescription came to $599.62. I could not afford such a huge amount to I opted to take half of the prescription on the spot and the balance later on.
I called United Healthcare to find out why there was no coverage at all. The representative tried to be helpful but explained that the particular drugstore I went through was not "NDC" approved or certified, or words to that effect. She also mentioned that under normal circumstances, this medicine would indeed be covered. So I found another drugstore that could obtain the medicine and also honor my insurance in the future.
Since the medicine is supposed to be covered, the representative said she would send me reimbursement forms, which she did. She also said she would call me again to see if things were okay, but she didn't.
I filled out all the forms according to the instructions and furnished receipts. A few days later I received my response. I was sent $161.73 as reimbursement for ½ of the prescription. Zero for the second half. The reason given was that it was refilled too soon after the initial prescription. This, of course was blatantly wrong. There was only ONE prescription. NO refills. I could only afford to pay for half of it at the time and picked up the second half weeks later. Very strangely, no one I speak to at United Healthcare seems to understand this simple premise. ONE prescription, paid for in TWO payments. Yet again and again it has been perceived as a refill.
I called United again and the young woman told me I could fill out forms for an appeal. I refused to do that. Why should I, knowing that the same response would likely come back? I insisted on speaking to a supervisor. After initial difficulty grasping the simple scenario, the next person finally did understand, I believe. But the records he had to refer to seem to show little detail and few facts about all that had transpired so far. This is a theme that seems to run through all communication with United Healthcare to date. Whatever records they have on hand seem to contain very little information about the customer they are speaking with.
This employee said he would look into it but I never heard from him again. So I called the "special" number he gave me and got to speak with a new person. By now, between being on hold and actually explaining the situation, I had spent at least three hours on the phone and gotten nowhere.
I called again and started from scratch a few days later. I wound up talking to yet another supervisor. She was helpful and promised to stay on top of my "case" and return my call within 24 hours. To her credit, she did get back to me, albeit six hours late. Her call was just to inform me that they were still working on my "case, " but no decision had been reached.
How difficult is this? What decision? How much clearer can the situation be? I simply broke up my payments to the drugstore for ONE prescription. And then I was reimbursed for ½ a prescription and penalized because of a falsehood—that it was refilled too soon when in fact it was never "refilled" at all.
I told this particular woman that my problem was now going to get worse because I need to have the prescription refilled, this time at a Walgreen's, which does take this insurance. The problem? They are going to charge me $434.74 in order to meet the deductible. This deductible has clearly already been met by my earlier prescription yet United is treating it as if I had never had any earlier prescription at all.
The woman said she would stay on top of my case and call me back the next day. Several days have passed and I have heard nothing. I refilled my prescription through Walgreen's and was charged the total deductible as if I had never paid for any prescription to date. This came to $434.74 dollars.
Bottom line? I have shelled out over $1034 for two prescriptions I have been reimbursed $161.73 to date. WHAT INSURANCE COMPANY PAYS THIS LITTLE. THIS VIOLATES THE PLAN AGREEMENT I SIGNED UP FOR WHICH OFFERED TO PAY MUCH MORE.
Obviously, I have a problem. But I now know that United Healthcare's run much deeper. Their inability to keep and maintain adequate member records, their lack of internal communication and genuine customer service indicate issues that are pervasive and endemic. The stress of dealing with them on the phone has become intolerable.
After complaining to the Better Business Bureau and other agencies through the letter above, I received a call from a woman named Casey from United Healthcare. She was polite and explained to me what had happened with my case— No. STOO4286AD. Apparently the various submissions for payment had crossed paths, causing some confusion. Ultimately I WAS OWED payment for the second half of the initial prescription—another $161.73. The first refill, from Walgreens was high to cover the deductible for the year. I agreed in principle, happy to receive something, anything back. She gave me her phone number so I could contact a real person. [protected]).
A few days later I received THREE copies of an identical letter dated June 6, from SUZY NUNEZ, Appeal Rep. This letter stated that "We decided to overturn the denial." I would be paid within 30 days, the letters said. EUREKA! After countless hours on the phone and computer it looked like I might actually get what was coming to me— a whopping $161 dollars!
On the same day received what seemed to be an unsigned follow-up letter, dated June 8, from Casey's department. It reviewed what was discussed and stated that they were filing a claim for me. No harm done. Everything finally settled. No quite…
The next day I received another letter —Notice of Denial of Medicare Part D Prescription Drug Coverage. Herein, my claim was denied once again, even though Ms. Nunez wrote and told me that the denial had been overturned. Again, the information in this notice was incorrect and back to square one where I had started. All the information failed to relate to the initial prescription, a single script for 30 days. Not two for the month.
I will be more than happy to provide this information and documentation to anyone who is interested. No matter how you look at it, an insurance company that only pays $161 out of more than $1000 paid by a patient should be considered criminal. The cost comparisons of different plans provided by Medicare showed that significantly more should be paid. This is an outright violation of their contract with me as a patient and customer and I will now aggressively seek others in the same boat in the hopes of initiating a class action suit against this incompetent company and its fraudulent practices.