United HealthCare Services

The UHC plan for the state of MO is suffering greatly due to the poor management and constant harassment by the provider services supervisor, Brandon Thomas and project manager, Rebecca Profest. The providers and staff both are frustrated due to the lack of poor education and training provided to both parties.

For example, in member services when an agent is struggling and there is a chance that the KPIs for the month won't be met, the agents are pulled off the phones to ensure no other mistakes are made that would jeopardize the projected bonus for the month. This plan is now being implemented on provider services. This is cheating UHC out of their money in my opinion.

Provider services has met their numbers for months on end, however now are struggling. Not drastically but suffering nonetheless. The trainer is not training them properly, there is no refresher training going on or anything to keep the agents fresh. They are chastised for not meeting numbers but not given the necessary tools to get them back on track. The trainer is sitting all day doing absolutely NOTHING when she does not have a class. Not even in jabber to assist with questions that may arise during the day. Rebecca has done nothing with this information when given feedback from the agents. She is allowing her to do whatever she wants.

Providers are calling in to have the agents review full policies and manuals with them when this should not be happening. however, Brandon has instructed them to embrace the gray which them contributes to their AHT not ever being able to be met. The providers call in and request Brandon to have claims paid and he gives them false hope even for things that are in black and white. Then after this issue of theirs is not corrected after he has given them the appropriate modifiers or codes to use, they complain to the agent and then Brandon has a hard time remembering even assisting this provider which then ends in a negative survey on the agent.

Agents are being targeted by Brandon whenever they register a complaint against him with HR. They are targeted and mistreated in hopes they will go ahead and quit. An agent in particular, Karen DeVose. He is doing any and everything he can to get her fired. No matter if legal or not. She made a complaint against him docking her timecards and she won that complaint and ended up being compensated. Ever since then, she is picked apart every single day. Her calls are reviewed more than others, she ends up with more failed audits even if it is for something that could have been feedback. This is also the situation with the UES ambassador, Jennifer MOrris. Strong agent, but she questioned him one time and she is being targeted now. Has the most surveys of the provider side but she is not being used to coach the others to get their UES scores up since he is not fond of her at the moment.

Another issue: the disrespectful emails and jabbers in regards to the BM, Laquina Washington. She is being completed disrespected and presented to be incapable of performing her job duties. They have made multiple complaints against her to the health plan in hopes of getting her replaced. The inappropriate memes and slick comments via Jabber, were too much. An audit was performed on Jabber and email usage when the plan first went live back in May of last year but another one should be conducted and you will find all kinds of things.

The attrition rate for provider services is higher than ever due to the poor leadership and blatant favoritism displayed. There is no trust and no desire to get the staff back into shape other than issuing write-ups. The appropriate training or coaching is not there and the stats, agents and most importantly providers are suffering.

Multiple emails have been sent to Rose's HR Dept by multiple agents but most issues go undressed. The plan is suffering and the complaints against the health plan are becoming more frequent.

I was schedule for back surgery on 6/25/2018. The surgery was scheduled 2 months prior to the surgery date. I was informed at my pre-op appointment, 1 week prior to my surgery. That a peer-to peer was required. This was not completed and surgery was re-scheduled for 7/6/2018. I was again informed at 5:00 pm the day prior to surgery that surgery would again need to be canceled due to insurance only approving part of the surgery. Meanwhile, I'm in pain. I have scheduled off of work. My shifts are covered. I don't have the kind of job where I can just go to work when plans change. I have called UHC multiple times and I get the same run around. They just take your money and look for any reason to not pay for services needed!

I paid around 1800 dollars to visit emergency and other than that 166 dollar bill was due to be paid by insurance company. I waited for a month and then I received notice from the hospital stating the bill was not paid. I called uhc and they told that they are going to settle the amount within 10 working days. I called the hospital and told them the same. But I again received a notice after few days that they haven't received anything. Then I contact uhc again on their helpline and they told it will take another one month to settle the dues. I contacted the hospital and they said pay at least 10$ so that they can hold it. I did the same. After one month I again contacted uhc and they said they are not gonna pay it. Is this how an insurance company works?

Is this the way they serve their consumers?

I am paying money but getting nothing out of them. Completely useless and unprofessional behavior. They are making people fool and wasting their time.

Received one month supply on 4/26/2018 for $20.00 copay.
Was informed that my refill for today 5/5/2018 would be $40.00.
When I called to inquire about the change 5/5/2018, I was told to go back to the pharmacy and was rudely cut off from the conversation. Spoke to both united representative (tara) and representative for the prescription service.
Member id #921142993, group # 713585.

Please reply via e-mail. Thank you.

Our family has one account - who needs to keep track of multiple family logins for the same account - stupid! I am on the account but Kimberly wouldn't give me any help or service when I got locked out of my account. Unacceptable. I am the wife of the policy holder and on the account myself - I am not a girlfriend. Why do things have to be so difficult - especially for a service that we PAY for! This isn't free insurance! No form of customer service at all.

She has been trying to get her Nissen Fundoplication/hernia repair surgery approved since Feb 2018 and has been denied twice. UHC isn't even reading the paperwork that Dr Don Selzer from IU Health Hospital is sending to them. They are denying saying it is bariatric surgery and laparscopic and they do not pay on either. Well-it's not bariatric and Dr Selzer has send the 2nd paperwork in with every other sentence saying this is not weight loss surgery. She has severe acid reflux which she has went through all testing to prove how bad it is and hiatal surgery repair. Prescription acid reflux meds do not help her at all. Also I tried to call your phone number busy and cannot get through. The customer service at UHC is not helpful at all and told her there isn't a denial dept and won't let her talk to denial dept(which there is-because she has talked to them previously) and they say they cannot transfer her to a supervisor which is also a lie. Our next step is a letter to CEO OF UHC. If someone that can help will call her- [protected] after 3:30 eastern time.

On April 20th 2017 I had a knee replacement done at New England Baptist Hospital in Boston.
I had my primary care send over a referral for 90 days which was what I was told to do. I had 3 follow up visits after surgery which were supposedly part of the original surgical protocol. The Dr. office scheduled my third post op visit for July 21 2017 . I was not notified by either United health care nor the Drs office that i didn't have a referral for July 21st as it had expired. On March 30th of 2018 I was notified by the Dr's office that I could not see the Dr. for my yearly check-up as i had not paid my bill from the previous July 21 2017 had .I then spent the next 20 days trying to resolve this . I made at least 5 phone calls to customer service each time having to talk to a different person and each time i was told it was all taken care of . as of today April 20 2018 it is not straightened out. This is my second year with United Health and rest assured it will be my last. I have had 7 hip replacements and a knee. The only reason I am walking today is because of this Dr. and now I cant see him again until I pay this $225.00 bill. I do believe that this problem originated with The billing clerk, but United should have contacted me as soon as they knew I needed another referral.
Your customer service department is a disgrace.

my name is
Sandra Cole
147 PIne Avenue
Sturbridge Ma 01566
[protected]
I have AARP Medicare complete
Member ID [protected]-00
Health Plan [protected]

Hey United Healthcare your representatives are getting more rude and rude everytime we call them. I spoke with a provider services rep named Beth K. and she is so rude, keeps cutting me off when i was asking her questions and sounded annoyed when i ask her questions. no courtesy at all, no pls and thank you, i asked to be transferred to the PA dept and she just transferred me without saying anything. i udnerstand they get many calls like this and i work in the same industry but i make sure that i am nice and polite. I was also transferred to Amy Wolfe from the PA dept and she is just the rudest person ive ever talked to. she keeps cutting me when im in the middle of telling her the reason i was calling, and same thing, she sounded annoyed and mad that im calling her. these people shouldnt be working in customer service if theyre just going to be this rude.

One surgical procedure was done for my husband on 11/14/2016 that resulted in an EOB created 02/14/2017 for the total charges of $13790.00. At that time, one line item on the claim was denied as duplicate. UHC processed the claim and I paid my share to the provider(s) also in February 2017. On 5/10/17, UHC created another EOB reversing 100% of the original charges. On 3/22/18, UHC created two more EOBs again reversing 100% of the original charges. On 3/22/18, UHC created yet another EOB (5th on in the chain of EOBs), reprocessing the entire bill and recoding the line item that was denied. Now UHC is claiming that I owe an additional $698.53 to 'clean and stich the wound' that was already paid from the same EOB for $492.39. Not only is the line item still a duplicate but the entire resubmittal goes against the UHC claims appeal process that states that appeals must be submitted within 12 months from the original EOB. I am trying to work with the UHC online messaging system for resolution. A UHC rep named Harry K who has not read the UHC appeals process document carefully is trying to convince me that 5/10/17 is the right date for the original EOB. If this is not resolved by the end of this week, I am taking UHC and Harry K to court for harassment. Needless to say, 2/14/17 is not and never will be 5/17/17 and 2/14/17 is more than 12 months so therefore Harry K is dead wrong and on his way to being fired.

Our daughter had an MRI done on her shins...nothing exceptional, took 30 minutes. The provider charged $16, 000 for this basic service. We thought it had to be a mistake, but when we contacted United Health Care, they said this was the contracted fee with the facility. We were required to cover $1, 200 of this fee. This is just insane! We have family members who have had MRis on the brain with dye contrast that took over an hour, and were not even 1/4 of this charge! Who could ever approve this kind of outrageous fee for a 30 min MRI?! We would have thought that united health care would look into this, but instead they said too bad, this is the fee, and we must pay the provider.

I'm continually being denied for a previously authorized rx, stating that they "have not received the appropriate documentation"!
I can make 2 different calls to the customer service line.in one call they will inform me that they need additional documentation from my physician or their pa.in another phone call they will not be able to locate me in the system.
I have tried to play by their rules regarding their progressive approach to the narcotic problems. Unfortunately, the rx's they are requiring me to take as an alternative has been giving me other health problems. So, I requested going back to what "was working" for me. And, i've had nothing but problems. My pain mgmt. Dr. S office is exhausting their patience with the inept way that this medical insurance co. Has decided to carry on. And I am becoming personally ashamed of the way they have been behaving towards myself and the additional burden they are placing on my dr. S office to provide documentation multiple times.

I notified unitedhealthcare on 12/7/2017 I have other health coverage and want to cancel their policy. ok no problem we will send you paperwork which they did faxed them back my other insurance then they send me a bill for 1/01/2018 I call them and they said I was disenrolled yes I know they said don't worry about it. then I get letter in mail saying as of 1/01/2018 the plan no longer covers my healthcare or prescription drug cost then they send me a bill for 3 months of coverage I don't have.but my complaint is unitedhealthcare wont inform medicare they said it can take 90 days.when I try and fill my medications medicare is saying I still have unitedhealthcare which I don't my unitedhealthcare #[protected] I have copd and high blood pressure and its getting worse because of them.thank you

HI i am the office manger for vital medicare care located in Mooreston Nj 08057. We been trying for a whole year to be in network with UHC Medicare plans. Dr Gami always been a participating provider for all of UHC plans all of a sudden with any warning we were taken off the Medicares plans. Dr. Gami is highly upset that no one has called us back. we need to know who is all representative so we can have this problem solve!

Case # a013796284 & a013079807 date: october 31, 2017
Patient: jeanne v. o'donnell
Member id # [protected] (under cobra coverage)
Standard chartered bank group # 231709
United healthcare (aka uhc) coverage through 2/28/17

A complaint for non-payment of my surgeon's claim was sent to the north carolina department of insurance. since my insurance policy with standard chartered bank is an erisa (self-funded) policy, the complaint falls under the jurisdiction of the united states department of labor. per my discussion with becky johnson at the department of labor office, I am informing you of my intent to pursue legal action for non-payment of my claim if it is not paid upon receipt of this letter. by federal law, you must respond within thirty days of the date you sign for this letter, sent certified/return receipt.
A claim was submitted for my surgical procedure performed by john alex thomas, md on february 17, 2017. prior to the procedure I had called united healthcare about my coverage since this neurosurgeon was listed as out of network. it was your representative who told me about gap coverage for doctors who are listed as "out of network" to be temporarily covered at the "in network" rate of 80% when there is no other "in network" surgeon available to perform the procedure within 30 miles. indeed, there were none closer than charleston, sc which is 180 miles from wilmington, nc, the location of my surgeon.
So I pursued that avenue with crimson brandon, surgery scheduler for dr. thomas. the day before my scheduled surgery she informed me that your company had approved gap coverage for his services at the 80% coverage rate. many hours were spent on crimson's part, and mine, getting everything in order so that I could proceed with the surgery. yet, even after crossing the t's and dotting the i's, your company decided to pay dr. thomas at 50%, according to one of the representatives that reviewed the claim.
I had spoken with representatives and supervisors at uhc on four different occasions over the months about this and was promised each time it would be corrected and residual payment made. my surgeon also filed an appeal by fax, and it was months before I discovered via phone call to uhc that nothing was done because the representative could not read part of the faxed documents. why wasn't the doctor's office notified of this?
Both I and the doctor's office personnel supplied abundant documentation for not only the gap coverage agreed upon, but also the procedure required for my surgery, allograft code # 20930 (case # a013079807), in august when your company stated you would only cover code # 20936 which is an autograft using my own tissue. when is it even ethical for an insurance company to decide what surgical procedure a patient should have? this is precisely why dr. thomas chose not to be a part of your network.
His office supplied doctor's notes, bone density results from three days prior to my surgery, and hip x-ray notes from three months prior to the surgery, justifying the need for the allograft vs. an autograft. I have degenerative hip changes and osteopenia. using a graft from my hip would have greatly increased post-surgical morbidity. see case # a013796284 for the code # 20930 approval.
The total claim submitted by my doctor for his services were $22, 728. your company paid $16, 728 which amount to 73.6%, not 80%, which would have been $18, 182.40. also, by the day of surgery I had met not only my $800 deductible, but a total of $1012.47 by 2/16/17 of my out of pocket maximum of $2500 in network. combine that with $1191 paid to the hospital for their charges and that equals $2203.47. so any charges exceeding $296.53 (the remainder of the $2500 maximum), including the $6000 from my surgeon, fall under 100% coverage due to the out of pocket maximum being met. this also includes the $100 I paid assistedcare management group for my post-surgical rehabilitation.
All other bills have been paid appropriately by uhc and I have settled any remaining balances with them that were my portion of responsibility. dr. thomas is still due $6000 from your company and I am due $100. I know from serving seventeen years as a pharmaceutical representative, calling on physicians, that your company is notorious for non-payment of claims. if you elect not to pay these bills then I will have no other recourse than to take legal action against your company and send a copy of that recourse to the insurance commissioner. this will include not only the amount you owe, but an additional $10, 000 for personal pain and suffering as well as additional costs for physical assistance in household chores and caring for my pets. the emotional and physical stress I have endured from this has prolonged my recovery by a continuance of severe sciatic pain, causing a reliance on muscle relaxers and occasional need for opioids to sleep. this level of pain and associated medications should be non-existent at this point in my recovery with as well as the procedure went according to my surgeon. the increased pain is due to restless sleep putting undue stress on the nerves in the surgical area from tossing and turning. this is a direct result of the emotional and physical stress your company has caused me due to a lack of resolution of this case.
In summary, you can save us both the grief and your company a greater sum of money by at least following through with your contractual obligation, and paying dr. thomas what he is duly owed.
See supporting documentation.
Sincerely,

Jeanne v. o'donnell
Cc united states department of labor

[protected]

I HATE United Health Care. They do not offer phone or web support on the weekend when most people are off work and are able to make contact. They can NEVER seem to get your PCP corrected and deny your claims. My husband and I pay over $1400 a month in premiums to them and on top of that we have to continually call to try to get either claims or other crap straightened out. Their RX provider requires us to use CVP, which doesn't have a store within 50 miles of us, except for Target, which only has locations in the valley or clear up north, so we cannot get there conveniently. Optum RX make it so hard for our PCP's office to work with them that they give up and we are supposed to try to create three-party calls between our health care provider and OptumRX (many times because Untied HealthCare decides what medications are in our best interest, even thought their off-brand (that is weirdly more expensive) leaves blisters all over my husbands body. Does arrogant United Health Care think the only f#g thing we have to do in life is work with them. FU.

I have received two letters from United Health were it was clearly mentioning about my medication and complete diagnoses. I would appreciate if United Health would not send any letters describing any diagnoses. What ever I have it is strictly between my Dr. and I. I don't needs to know from you what kind of medication is it and what diagnose I live with.

So I only have had an RX plan, had one last year, 2017, that did not cost any moneys, this year they just figured I would take the same plan, but will cost me money, I called and asked to have this canceled right away, my information was confirmed and was canceled, cost for the same plan that was free last years was $44.00 and some change, any way did not want any RX plan, Oh but wait sir, I have a plan that will not cost you any money also, so lets sign you up for that RX plan, sure this is great if it will not cost me any money the RX will cost a bit more as a co pay, was said to this rep if it cost any money I do not want it, No its free at no cost to me, 1st rx plan canceled, new free plan, weeks later get the info in the mail, and it cost $24.00 and some change, I cal to cancel it and this time I have ti go through weird questions and ask to talk to a supervisor, in short was emailed the form, copied it faxed it to cancel the plan, told I was lied to of cost to be free and cost me money, so canceled this plan, weeks later I get a bill in the mail for the 1st $44 moneys and then a part of the free RX plan that cost money of $24 and some change, call to see whats up with why I owe them money, was said I have to pay for the time it was activated tell it gets closed with the paper work, what, I said, I never used there plan, canceled the 1st large one, canceled the 2nd rx plan never used but still have to pay,
NO this is not right, never wanted there stuff, canceled and they say I owe them money $55 or more and some change,
This is not right, the 1st plan was canceled right before the 1st of the new year, was charged any way, the 2nd rx plan was said to be free, I said I do not want it if it cost anything, no its free was said, the it cost money was lied to of cost not free, and now owe United Health Care for back month of the 1st plan and a part of the 2nd plan and its not cancelled yet,
These people need to be stopped from ripping people like me off, lied to about cost, charged for something I did not want or ask for and then still have to pay even though it was never used and has not yet been cancelled still by UHC,
That should be it, hope you got the idea, I hate these people, owe money for something I did not want or ask for, had to cancel it, and told I still have to pay, this is crap to say the least
Thanks for your time
1st rx plan cancelled Friday the 29th of Dec 2017
Then all happening this year today is 01/18/2018 and all this happened in this time but owe fro the 1 month of the LG RX even though it was canceled before the 1st of the year and part of the smaller RX plan that was to be free, but really cost money.

I purchased a Care Improvement Plus God Rx (Regional PPO SNP) plan from United Health Care in November 2017. At the time I purchased the policy the agent asked for and I provided the name of my cardiologist so that they could verify my heart disease which qualifies me for this plan. The agent told me they would contact the physician and ask for a copy of my records to verify. I called the physician to alert them to the call. Then on January 7th I got a letter dated January 4 from United saying that they had not received verification of my health condition and that I was being removed from the plan effective February 1. I called immediately and was told that the physician never responded to the request. I called the physician and they said they never got a request. Now today, January 16th after some 18 telephone calls I finally learn that United Health never contacted the physician, never faxed a request for records and that they were just going to let me get kicked out. I found an agent who told me that she would put me on hold, call the department responsible for sending the fax and have it sent while I was on the line. She came back several time over the next 21 minutes to encourage me and to say that it was being sent. Then she comes back and says sorry but she had just learned that it takes seven days after a request is submitted before a fax for records is sent. I told her that I didn't think that would work with the deadline and asked why they waited from November to January without ever trying to service this policy. She did not have an answer. I asked to speak with someone who could address this issue. She told me that there was no one. She told me just to wait until after February 1, file an appeal and then work to get back in the program. My experience here has been that they really don't care. They just do not care.

It is painfully obvious what United Health Care has been doing and it will not work on me! It is obvious that UHC has deliberately delayed and denied since 9/27/17 my healthcare treatment, putting my health (and life) in jeapordy. The UHCr obvious tactic being to kick it down the road long enough to roll over into a new year. Due to more medical issues than usual this year, I have met my maximum out-of-pocket in 2017.

Attached you will find the long string of messages. You will find my diagnosis of Severe Obstructive Sleep Apnea. You must authorize treatment with CPAP immediately or this will escalate. I will fight for my rights….fight for my life.

Obstructive sleep apnea as severe as mine doubles my chances of heart attack and doubles my chances of stroke. Not to mention, healing from my surgery this year has been slow. Since the body heals during REM sleep, my entire health has been put at risk. I am oxygen deprived all night and tired all day.
I will not roll over and go away. I've been trying to get this health concern addressed since 9/27 amidst all of your constant delays and denials. The diagnosis is clear. The health consequences of untreated severe obstructive sleep apnea are clear. Release an authorization for my treatment immediately and I must take care of this in THIS calendar year!
I am quite resourceful and will escalate this issue if I am not contacted with an authorization immediately.

Connie M. Clark (DOB 08/17/1956)

I am a 61 year old disabled woman. Under the recommendation of my primary care Dr., I was referred to a Pain Management specialist. I have multiple spinal issues, as well as PTSD, Anxiety disorder, and a mild seizure disorder.
The Pain management clinic I had been attending for almost 3 and 1/2 years, suddenly decided to stop excepting my United Healthcare WellMed advantage plan. We were in the midst of tapering me down off of pain medications, with a plan all laid out to address withdrawal symptoms. I asked my primary care Dr. to refer me to another clinic to see me through and support me while the medication taper was in progress.
I began to experience very uncomfortable withdrawal symptoms, for which I asked for supportive medications which are commonly prescribed for this issue. I was told they do not do this.
I finished the taper and released myself from their care.
While experiencing moderate withdrawal symptoms, I reached out to my Psychiatric nurse practitioner, who prescribes me anti-anxiety medication and she informed me that it was not her specialty to help me. I then reached out to my primary care dr, which I was advised to do, only to have him tell me that only the prescribing Dr. could refill my anxiety medications.
This provider was on vacation for a week, so I called Primary care once again.
His nurse returned my call to tell me that he could not and would not refill that medication, and that I would have to wait until after the holiday week and speak to the prescribing nurse practitioner; which would be more than a week.
I was told, "No one ever died from withdrawals" via cell phone. A very highly inappropriate response from any medical provider.
Aside from all the normal symptoms I am experiencing, the anxiety has caused me to have multiple mini-seizures, causing me severe discomfort.
I am completely disappointed with this type of response from my providers at WellMed. I see no reason to allow anyone to go through this most uncomfortable process without the support of any and all medical treatment available.
I understand the law-as I have studied it in college, and I am familiar with the recent restrictions placed on Drs regarding the prescribing and dispensing of controlled substances. However, that is no excuse to allow any patient to experience the discomfort and suffering that I have.
I would appreciate your review of this complaint.
My email is [protected]@gmail.com.

May you have a blessed Thanksgiving, and I hope to hear from you as soon as possible.

Regards,
Karen Thiemermann
[protected]