UnitedHealth Group (Headquarters)

Additional Notes

Complaint: They dropped my doctor the first of April but I can't change to another company until next January. I can use him but they won't pay anything.Dr. ******* has been my doctor for about 3 years following a 4 year search for a doctor after moving here. He made an "error" that put him on probation but didn't suspend his license. All the other insurance companies he deals with have no problems continuing with their contract but UnitedHealthcare sent out a letter dated April 5 saying he was no longer with them. I called 3 different customer service reps and 2 of them told me that he had dropped UnitedHealth instead of the other way around. I've also called ***********, who made the decision to drop Dr. *******, and he said that UnitedHealthcare just follows the government rules. When I asked why the other companies didn't have the same rules he said he followed UnitedHealthcare's "interpretation" of the rules.I've been told by UnitedHealthcare that they will find a different doctor for me and they'll honor the contract or I can continue working with Dr. ******* and pay all my own bills.So it all comes down to they'll be getting paid for the contract they made on January 1st but won't honor their part of the contract which was for me to receive services from Dr. ******* for this calendar year. According to the Medicare rules I can't go to another company until next January 1st. I told *********** that if they wanted to drop Dr. ******* at the end of the contract year that was fine because I could move to another company at that time but 3 months into the year I'm locked in by Medicare rules.

Business Response
We are in receipt of your inquiry dated 03/29/2013, regarding your request for assistance from ***** L. *******, who has been identified as a member of a Medicare plan. This plan is regulated by the Centers for Medicare & Medicaid Services (CMS). Due to Health Insurance Portability and Accountability Act (HIPAA) guidelines, we are unable to respond directly to you regarding these concerns.

Since your letter included a copy of the enrollee's correspondence and/or a description of the complaint, we will be responding directly to the enrollee.

United Healthcare has established an appeal and grievance resolution process in accordance with the Centers for Medicare & Medicaid Services (CMS) regulations. It is our position, and that of CMS, this process provides Medicare members with adequate recourse regarding any issues they may experience with their coverage, or any other services they received in connection with benefits provided by us. We want to assure you this matter will be investigated and resolved within the CMS timeframe.

This information has been forwarded to our Appeal & Grievances Department for review and a response will be mailed to Mr. ******* in writing upon completion of their case within 30 days.

Complaint Resolution: Company resolved the complaint issues. The consumer acknowledged acceptance to BBB.

Additional Notes

Complaint Category: Advertised price not honored

Complaint: The price for Singulair that was listed on the OptumRx website and the price that was given over the phone, is not the price that I was billed.
On several occasions I contacted OptumRx (mail order pharmacy) on the phone to get to a price for several allergy medications. I also used the OptumRx Drug pricing link on their website to price medication. I made another inquiry call on approx 3/18 and spoke with a rep: Stephanie to verify the price, the price she gave me for Singulair CHW 5mg/Qty 90/was $25. I also have printed copies of the Medication Pricing sheet for Singulair that shows the same price of Singulair CHW 5mg/Qty 90/$25. I have printed price sheets with the same info for 3 different dates. They are printed on: 03/14/2013, 03/18/2013, 03/21/2013.
I had a prescription called into OptumRx on 3/19 for Singulair. On 3/21/2013, I went online to verifiy that the medication was being processed. I saw that the price I was being charged for the Singulair was $380.84. I then called United Healthcare/OptumRx and was transfer to a rep:*******, (might not be correct spelling of her name). She said the price that I was seeing online and the price that the rep gave me over the phone was not correct.I explained all the copies of the online pricing I had and also the numerous calls I made to verify the cost of the medication.She said she would check into it and call me back.She called me back on 3/21 at 2:27pm from the #************. She said the price I was being charged would be the $380.84. I told her I felt I should have the price honored that was listed on the website and the price I was told when I called in.She said she could not do that, I would have to pay the $380.84.
At approx: 8:30am on 3/22, I called OptumRx and was transer to another rep: ********. I explained the situation to him. He said he was aware that the price that I had seen the last few weeks was not correct. I told ******** I felt the price they advertised should be honored and he said he would not honor it. I told him I wanted to cancel all the prescriptions that I had on file. I did not want to have my medication filled at OptumRx because I did many days of research and made many phone calls, only to find out the prices that OptumRX were advertising and the pricing info they were giving over the phone would not be honored.

Business Response
April 15, 2013

BBB of Minnesota & North Dakota
Attn: ******* *******, Sr. Mediation Coordinator
220 S. River Ridge Cir
Burnsville, MN 55337

RE: ***** *******:

Dear Ms. *******:

I am responding to your recent correspondence dated April 4, 2013, regarding ***** *******.

Due to the protections of the Health Insurance Portability and Accountability Act (HIPAA), I am unable to provide you with detailed information regarding the resolution of this issue without an authorization from ***** ******* to release her private health information to you.

UnitedHealthcare investigated this matter and responded directly to ***** *******. For more information on the resolution of this issue, please contact Ms. ******* directly.

Should you have any questions or comments, please feel free to call me. I can be reached during normal business hours at ************ ext *******.


Sincerely,
*************
Senior Consumer Affairs Advocate

Complaint Resolution: Company addressed the complaint issues. The consumer failed to acknowledge acceptance to BBB.

Additional Notes

Complaint Category: Failure to correct billing errors

Complaint: This is a formal complaint against United Healthcare for not paying an in-network provider for services rendered during a routine prenatal procedure
Back in 2007 I was pregnant with my first child. On 8/3/2007 I went to the Radiology Center in Lynhurst NJ for an untrasound and lab services. This was an in network provider and my yearly deductible had already been met. These services were to be covered 100%

Shortly after...I received a bill from the provider for $650. They stated United rejected the claim for some reason. So I called United who advised that they never got a claim. we went back and forth witht he "he said she said" and at the time being a 24 year old with a new baby ....I basically let it go and say I'm not paying it because this was covered and I don't owe this. You guys hash it out and get it fixed.

Fast forward to present day and I now I am unable to get a mortgage loan for my family because there is a collection from Amity Associates on my credit report for that same $650 charge from the Radiology Center....which United has still not taken care of.

So I call United again and they are able to pull this in the archives and Im advised on 1/14 by a lady there that ....oh wow! ....We did get the claim back in 2007 but whoever put the claim in put everything in the wrong fields and thats why the Radiology group never got paid out by United. she assured me she would get this taken care of and call me back within 24-48 hours. Well she never called me. I called in 72 hours later.....and they told me to keep waiting. so I did and then the following week i go online and see they reprocessed the claim....but they did so under the wrong member ID. They filed it to one of my more recent member ID's not the one i had in 2007. So the claim again gets rejected ...this time because they state it was before my coverage period. Well obviously ...because i had a different plan at the time of service. I know they have the right plan number too that i had in 2007 because they confirmed it over the phone multiple times and assured me this would be taken care of. So i call again ....they reprocess it again...i have to wait another week. The girl on the phone confirms the correct 2007 member id this should be under.

well sure enough the process it again under the wrong member id!!!! for the 2nd time!!!

So i call back. They are going to reprocess for the 3rd time. at this point im livid on the verge of tears. I speak to a manager she gives me her direct line....but wont return my calls. Then someone calls me about another claim they had been working on and I ask her to check this and she advises me part of the problem is that since its so old United Healthcare no longer has funds to pay on such an old policy! But they are still working on it.

At this point I do not care if the CEO of United needs to pay this out of his own pocket. This was an admitted mistake on the part of United Healthcare ...I find it hard to believe that a billion dollar company cannot take care of $650 bill that was their responsibility in the first place.

I am hoping that you can assist me to get this taken care of ....This is my last attempt before contacting the FTC, the attorney general, and suing them in court!

Business Response
February 11, 2013

Better Business Bureau of
Minnesota and North Dakota


RE: ***** **********

Dear Ms. *******:

I am responding to your recent correspondence dated February 8, 2013, regarding ***** **********.

Due to the protections of the Health Insurance Portability and Accountability Act (HIPAA), I am unable to provide you with detailed information regarding the resolution of this issue without an authorization from Ms. ********** to release her private health information to you.

UnitedHealthcare will investigate this matter and respond directly to Ms. ********** no later than Februay 22, 2013. For more information on the resolution of this issue, please contact Ms. ********** directly.

Should you have any questions or comments, please feel free to call me. I can be reached during normal business hours at ************ ext. *******.


Sincerely,

***********
Consumer Affairs Advocate


NOTICE: This communication may contain PRIVILEGED and CONFIDENTIAL information and is intended only for the use of the specific individual(s) to which it is addressed. It may contain Protected Health Information that is privileged and confidential. Protected Health Information may be used or disclosed in accordance with law and you may be subject to penalties under law for improper use or further disclosure of the Protected Health Information in this communication. If you are not an intended recipient, you are hereby notified that any unauthorized use, dissemination or copying of the information contained in it or attached to it is strictly prohibited. If you have received this in error, please securely destroy it and immediately notify the sender. Thank you.

Consumer Response
(The consumer indicated he/she DID NOT accept the response from the business.)
This is unacceptable. I give them permission to release information to the BBB as long as the published information is redacted on the BB site. I do not trust United themselves at this point because they have yet to resolve anything!

Business Response
Business informed the BBB via phone that they have responded to the consumer directly.

Complaint Resolution: Company resolved the complaint issues. The consumer acknowledged acceptance to BBB.

Additional Notes

Complaint Category: False or unsubstantiated claims in advertisement

Complaint: UnitedHealtcare used false advertising to win members, and then did not honor their advertised benefits.
Please asked UnitedHealthcare CEO ************** at ************ why her agent ************** approved the dental work and then not pay for what she approved?

Business Response
We are in receipt of your inquiry dated April 4, 2013 regarding your request for assistance from ***** *******, who has been identified as a member of a Medicare plan. This plan is regulated by the Centers for Medicare & Medicaid Services (CMS). Due to Health Insurance Portability and Accountability Act (HIPAA) guidelines, we are unable to respond directly to you regarding these concerns.

Since your letter included a copy of the enrollee's correspondence and/or a description of the complaint, we will be responding directly to the enrollee.

United Healthcare has established an appeal and grievance resolution process in accordance with the Centers for Medicare & Medicaid Services (CMS) regulations. It is our position, and that of CMS, this process provides Medicare members with adequate recourse regarding any issues they may experience with their coverage, or any other services they received in connection with benefits provided by us. We want to assure you this matter will be investigated and resolved within the CMS timeframe.

This information has been forwarded to our Appeal & Grievances Department for review and a response will be mailed to the complainant in writing upon completion of their case within 30 days.


Consumer Response
(The consumer indicated he/she DID NOT accept the response from the business.)
As of 4-6-2013, I still have not been contacted by UnitedHealthcare. I have ads from UHC, that show they are not honoring their ads and conditions to their members. This is false advertising to millions of their members nation wide. I would think that false advertising at this level would be serious and should be looked at carefully.

Thank you ******** ******* ************


Consumer Response
See attached doc 1


Consumer Response
See attached doc 2


Business Response
Thank you for forwarding this additional information received from Mr. *******.

I have forwarded this information our Appeal & Grievances Department to add to the case file being initiated for review of Mr. *******'s concerns.

Once again, response will be mailed to the enrollee upon completion of the A&G Department's case review within 30 days of the receipt of the original complaint. The Plan received the original complaint on April 4, 2013.

Please be aware that per CMS A&G guidelines, a claim appeal case can be extended up to 60 days maximum if necessary in order to complete review and response on claims dispute issues.


Consumer Response
Customer completed HIPAA release form. Please respond to the BBB with a copy of the complaints response.

Complaint Resolution: Company failed to resolve the complaint issues through BBB voluntary and self-regulatory process.

Additional Notes

Complaint Category: None of the Above - Credit, Billing or Collection Complaint Issue

Complaint: company sends out too much paper mail with no option to stop.
this company needs to offer a paperless option. they send out too much useless paper as a statement. i have spent over an hour online and on the phone to find out that its all "automatic". in this day and age there should be an option to opt out of this because as the consumer i don't want to waste all of this paper and i have ecological ethics i'd like to keep upholding.

Business Response
Due to the protections of the Health Insurance Portability and Accountability Act (HIPAA), I am unable to provide you with detailed information regarding the resolution of this issue without an authorization from ***** ****** to release his private health information to you.

UnitedHealthcare will investigate this matter and respond directly to ***** ****** within XX days. For more information on the resolution of this issue, please contact Mr. ****** directly.

Should you have any questions or comments, please feel free to call me. I can be reached during normal business hours at ************ ext *******.


Sincerely,

*******
Consumer Affairs Advocate


Business Response
Correction- Response will be issued to member within 10 business days.


Consumer Response
(The consumer indicated he/she DID NOT accept the response from the business.)
i appreciate that UBH will contact me directly. but until then i am not assured that an excessive amount of paper mail will stop being sent to my home. also, i am not sure about the "XX" days is a reasonable amount of time to respond to me. i request that they respond within the month.


Business Response
Thank you for the additional response posted by the Consumer. I apologize for the typographical error in my prior response. My correction comment noted that the response would be submitted within 10 days, however UBH did send response to the consumer on April 11, 2013.
*******
Consumer Affairs
************

Complaint Resolution: BBB determined the company made a reasonable offer to resolve the issues, but the consumer did not accept the offer.

Additional Notes

Complaint Category: Failure to provide promised assistance or support for products or services

Complaint: Was told by agents of United health care that newborn child will be covered by wife's insurance for first month of life.Was then billed $748 for baby.
My wife and I waited a long time to have our first child and planned out our steps to make it as easy as possible. One of the more difficult decisions was insurance. In the current insurance landscape in America, it is difficult to figure out what your benefits are going to include. As my wife and I looked to choose between our different insurance companies, we considered premiums, co insurance, well care visit coverage, initial hospital stays, and, most importantly in the first year: maximum out of pocket costs. Upon researching, we were certainly going to meet my wife's out of pocket in the first year.
My initial conversations with the benefits person at my wife's company (not your employee) and your benefits customer service representatives occurred sometime previous to her company's April and my company's May open enrollment dates. We were told that the baby would automatically be covered under her plan for the first 30 days after birth. We both sought council from the respective representatives from your company and my insurance company and these beliefs were confirmed.
As teachers, we receive our end of year contracts at the end of the school year (May for her, early June for me). As I was budgeting, I called again (June 7th) to confirm that the hospital stay would be covered by her plan. I was again told that the baby was covered under her insurance for the first thirty days. I was told that, if I was planning on paying my wife's maximum out of pocket expenses, there should be no surprises.
The day of my child's birth we were bombarded by questions like were we going to do the circumcision in the hospital, whether we wanted to get an initial vaccine (hepatitis I believe), and whether we wanted to do the initial newborn hearing screening. As these seemed elective, I called again to check with coverage and avoid unnecessary bills in a time of financial uncertainty. I was actually told that everything in the first 72 hours in the hospital was a hundred percent covered. This didn't really matter to me as I had planned on paying $3000 out of pocket to meet the maximum.
Post baby, bills have been rolling in. It's been difficult to decipher what we really owe to whom and who owes us money (due to providers asking for money up front). Last week (9/7) I called again to decipher our bills and see what I owe to whom. As our baby's name was showing up on one of the bills, I asked why that was. Your agent told me that was due to the fact that the baby was only covered 80% under the coinsurance not mentioning that it was going to be applied towards the baby's out of pocket maximum. I said that didn't matter as I was just trying to hunt down our $3000 maximum out of pocket. Even after this statement and knowing my intentions, the agent never mentioned the baby's maximum out of pocket contribution.
I took the day off work on September 11 to get to the bottom of our bills. My pay out on the bills was 473.40 over $3000. I called United Health Care back today and spoke with ********. She again told me that the baby was only covered by 80% under the coinsurance. I said I was aware of that but it looks like I am over my maximum out of pocket deductible by that amount. It was only then that she said that it counts toward the $6000 max family out of pocket or the baby's $3000 max.
I feel that your representatives had many times to mention this and never did. In fact, it was only after me asking if the baby's 473.40 was not going towards the max out of pocket that I received this information. Also, the baby was not added to the policy until after 30 days, so how could he have a separate out of pocket max? As such, I dispute this charge and wish to appeal the bill. We have also since received a bill for the baby's circumcision totaling 275.45. I would like to dispute that as well. Your agents misrepresented your services on multiple occasions.

Business Response
February 15, 2013

Better Business Bureau
Attn: ******* *******
220 South River Ridge Circle
Burnsville, MD 55337

RE: *************:

Dear Ms. *******:

I am responding to your recent correspondence dated February 13, 2013, regarding *************.

Due to the protections of the Health Insurance Portability and Accountability Act (HIPAA), I am unable to provide you with detailed information regarding the resolution of this issue without an authorization from ************* to release her private health information to you.

UnitedHealthcare will investigate this matter and respond directly to ************* within 10 business days. For more information on the resolution of this issue, please contact ************* directly.

Should you have any questions or comments, please feel free to call me. I can be reached during normal business hours at ************ ext *******.


Sincerely,

*************
Consumer Affairs Advocate

Consumer Response
(The consumer indicated he/she DID NOT accept the response from the business.)
They have already shared with us that their records do not show that that their agents failed to mention that our unborn child would have his own $3000 out of pocket max in the first month that he was covered under his mother's policy.
This should be expected. Which agent in their right mind is going to log that they neglected to tell me something. It would be easier to tell me than it would to log it. The fact that I made numerous calls checking my benefits indicates a strong likelihood of a systemic fault in how their benefits customer service representatives explain benefits.
The fact that their benefits representatives couldn't even tell me why I was paying over my $3000 out of pocket maximum indicates that they had no idea (much like myself and my wife) that the child had his own out of pocket maximum. They answer questions every day on benefits and are the "experts," certainly not someone at home in a health crisis. They are listed on the back of her health card as benefits experts.
I recommend not allowing them to hide behind HIPPA. Find a way to call United Health care and ask about an impending childbirth and coverage. Unless it has changed due to my complaint (which I highly doubt)I'll bet they will neglect to mention the child's $3000 out of pocket maximum and neglect to log that into the computer.
Again, it flies in the face of logic. If the child is not on the mother's health care plan and paying for premiums, why would you expect them to have their own $3000 out of pocket. They are covered on their mother's plan and a reasonable human would expect that to mean entitled to the same rules and coverage.
Regards,
***** and *************

Business Response
February 24, 2013

Better Business Bureau
Attn: ******* *******
220 South River Ridge Circle
Burnsville, MD 55337

RE: *************:

Dear Ms. *******:

I am responding to your recent correspondence dated February 19, 2013, regarding *************.

Due to the protections of the Health Insurance Portability and Accountability Act (HIPAA), I am unable to provide you with detailed information regarding the resolution of this issue without an authorization from ************* to release her private health information to you.

UnitedHealthcare will investigate this matter and respond directly to ************* within 10 business days. For more information on the resolution of this issue, please contact ************* directly.

Should you have any questions or comments, please feel free to call me. I can be reached during normal business hours at ************ ext *******.


Sincerely,

*************
Consumer Affairs Advocate

Complaint Resolution: BBB determined that despite the company's reasonable effort to address complaint issues, the consumer remained dissatisfied.

Additional Notes

Complaint: I needed special shoes and inserts and received a RX prescription from my doctor. I then called United HealthCare (UHC) prior to going to the provider I selected to make the shoes and inserts. I explained to the UHC rep what the RX prescription stated, and what provider I was going to go to. The UHC rep stated the shoes were not covered under my health insurance plan but the shoe inserts were 100% covered. I made my appointment with Central Prosthetics & Orthotics in Temple, Texas. I went to my appointment, saw the shoe maker. I paid for the shoes out of my own pocket at my expense. The provider submitted the claim for the inserts to UHC. UHC had now denied my claim to pay for the shoe inserts after the fact. I appealed this decision. UHC has denied my appeal. I am now being billed by the provider for $272.18 for the shoe inserts due to UHC denials.
Product_Or_Service: Shoe inserts
Order_Number: W0090909013
Account_Number: 956678872

Business Response
February 5, 2013

Better Business Bureau of
Minnesota and North Dakota


RE: ****** ******

Dear Ms. *******:

I am responding to your recent correspondence dated February 1, 2013, regarding ****** ******.

Due to the protections of the Health Insurance Portability and Accountability Act (HIPAA), I am unable to provide you with detailed information regarding the resolution of this issue without an authorization from Mr. ****** to release his private health information to you.

UnitedHealthcare will investigate this matter and respond directly to Mr. ****** within 10 business days. For more information on the resolution of this issue, please contact Mr. ****** directly.

Should you have any questions or comments, please feel free to call me. I can be reached during regular business hours at XXX-XXX-XXXX ext. XXXXXXX or directly at (218) XXX-XXXX.


Sincerely,

***********
****** ****** Advocate


NOTICE: This communication ****** contain PRIVILEGED and CONFIDENTIAL information and is intended only for the use of the specific individual(s) to which it is addressed. It ****** contain Protected Health Information that is privileged and confidential. Protected Health Information ****** be used or disclosed in accordance with law and you ****** be subject to penalties under law for improper use or further disclosure of the Protected Health Information in this communication. If you are not an intended recipient, you are hereby notified that any unauthorized use, dissemination or copying of the information contained in it or attached to it is strictly prohibited. If you have received this in error, please securely destroy it and immediately notify the sender. Thank you.

****** Response
(The ****** indicated he/she DID NOT accept the response from the business.)
My medical records have nothing to do with this complaint. It is an attempt by United Healthcare not to give an honest response on this matter. I called prior to going to the provider, and the United Healthcare rep was responsible to inform me that provider was "out of network" and failed to do so.

Complaint Resolution: BBB determined the company made a reasonable offer to resolve the issues, but the consumer did not accept the offer.