Moxie Posted June 16, 2015 Share Posted June 16, 2015 Holy crow, I am pissed. I got a letter from UHC today. It is a complimentary copy of a letter that they sent to my son's brand new therapist. The letter tells the doctor that they can't process her claim because we are delinquent on paying our premium!! I pay all my bills early. So, I get online and look at my account. Every payment is there and is credited a week before it is due!! So, now our new doctor thinks we are deadbeats who don't pay our bills!! Plus, the letter states that, since we receive a subsidy, we have an extra grace period to catch up. How is that ever any of the doctor's business?!? I am so mad. I am going to demand that they immediately mail a letter to her and me stating that this was their error and at no time were we late. So mad!! 6 Quote Link to comment Share on other sites More sharing options...
datgh Posted June 16, 2015 Share Posted June 16, 2015 I just got done trying to decipher our Horizon BC/BS insurance out of NJ. I have never had to deal with a more mixed up mess! They have codes for everything, claim I needed referrals for some things and other things not. No rhyme or reason. Just thought I would chime in as I am feeling insurance woes myself tonight and wanted to know you are not alone! 3 Quote Link to comment Share on other sites More sharing options...
Tap Posted June 16, 2015 Share Posted June 16, 2015 I understand your frustration and would hope they will make it right (but I doubt they will). Honestly, I bill insurance claims all day long for a pharmacy. I see this rejection a few times a day. We ALWAYS assume it is an error on the insurance's side, not the patient's. We assume that, because it is the case 99% of the time. The office will just call the insurance company, verify you have active coverage and then proceed from there. If you doctor does a lot of billing, I doubt that they will think anything of the letter and it will just get recycled with all the other garbage letters they receive. :grouphug: 7 Quote Link to comment Share on other sites More sharing options...
Melinda S in TX Posted June 16, 2015 Share Posted June 16, 2015 I'm currently fighting with United Healthcare too. They are refusing to pay for dd neuropsych eval that her neurologist ordered. Dd is having seizures and losing skills so they want a baseline. I'm fighting for them to cover another dd medication. There is an over the counter med, but she is allergic to it and her doctor ordered it compounded for her. She lives on this med, so we have to have it. Quote Link to comment Share on other sites More sharing options...
LaxMom Posted June 16, 2015 Share Posted June 16, 2015 I understand your frustration and would hope they will make it right (but I doubt they will). Honestly, I bill insurance claims all day long for a pharmacy. I see this rejection a few times a day. We ALWAYS assume it is an error on the insurance's side, not the patient's. We assume that, because it is the case 99% of the time. The office will just call the insurance company, verify you have active coverage and then proceed from there. If you doctor does a lot of billing, I doubt that they will think anything of the letter and it will just get recycled with all the other garbage letters they receive. :grouphug: This. They (all of them) also like to send letters telling people they're denying claims for random, inaccurate reasons, like not having a piece of information on the claim that is right there on the claim. It's not a new practice at all (though the premium non-payment "reason" is). I was firmly convinced 20 years ago that claims denial was a way of making money by (a) holding money while they make interest on it and (b) not paying out when people get tired and give up. I can't imagine any medical billing office taking anything in a rejection letter seriously. 5 Quote Link to comment Share on other sites More sharing options...
Butter Posted June 16, 2015 Share Posted June 16, 2015 It's even possible the doctor will never even see or hear about their reason for denial. Billing people see stuff like that constantly and just call the insurance company and then resubmit. Insurance companies are annoying. 1 Quote Link to comment Share on other sites More sharing options...
G5052 Posted June 16, 2015 Share Posted June 16, 2015 This. They (all of them) also like to send letters telling people they're denying claims for random, inaccurate reasons, like not having a piece of information on the claim that is right there on the claim. It's not a new practice at all (though the premium non-payment "reason" is). I was firmly convinced 20 years ago that claims denial was a way of making money by (a) holding money while they make interest on it and (b) not paying out when people get tired and give up. I can't imagine any medical billing office taking anything in a rejection letter seriously. All that and more around here. The medical world has so much data and inefficiency wrapped up in it that I wouldn't take any of it personally. Dealing with it for our family requires constant vigilance and persistence on my part. My recent adventure involved a claim appeal. First they lost the documentation we sent. So I sent it again. Then they denied it because the documentation was late. Then I reminded them that they lost the first set. They said they'd reconsider. They denied the appeal. Oh well. We negotiated the bill down some months ago during this and are still paying on it. Then I got a letter that they have reconsidered and are reopening the appeal. I'm not optimistic, but that's the norm. Quote Link to comment Share on other sites More sharing options...
Trish Posted June 16, 2015 Share Posted June 16, 2015 This. They (all of them) also like to send letters telling people they're denying claims for random, inaccurate reasons, like not having a piece of information on the claim that is right there on the claim. It's not a new practice at all (though the premium non-payment "reason" is). I was firmly convinced 20 years ago that claims denial was a way of making money by (a) holding money while they make interest on it and (b) not paying out when people get tired and give up. I can't imagine any medical billing office taking anything in a rejection letter seriously. I agree with all of this. I think the Frustration and Incompetence Factors are ratcheted up to benefit the insurance companies, buy them time, and hopefully (for them) they won't have to pay at all. We've had claims denied because we abbreviated Florida instead of spelling it out. 1 Quote Link to comment Share on other sites More sharing options...
Twigs Posted June 16, 2015 Share Posted June 16, 2015 :grouphug: :grouphug: :grouphug: Quote Link to comment Share on other sites More sharing options...
Greta Posted June 16, 2015 Share Posted June 16, 2015 We have UHC too, and it's awful, though I suspect it's actually pretty typical. For the first two years that we had them, every single time we submitted a claim we received threatening letters from them saying that if it was a fraudulent claim we would be prosecuted. Every single time that we went to the doctor, we received a threat from them! They also claim, on our plan, to pay 80% of our medical bills after we've met our deductible, but of course that isn't the way it works at all. They pay 80% of what they feel we "should" have been charged, not what we were actually charged, plus of course they will find any excuse possible to not pay. For example, once the lab at my doctor's office was very busy, so they sent the bloodwork to another location within the same provider's network. The same company, just a different location a few miles away. So UHC wouldn't cover it. Jerks. I'm sorry, OP. But the good news is, if your doctor has any experience with UHC at all, she probably knows to just ignore them. :D 1 Quote Link to comment Share on other sites More sharing options...
wonderchica Posted June 16, 2015 Share Posted June 16, 2015 I agree that the doctor will likely never know about the letter. Billing will just re-submit. Quote Link to comment Share on other sites More sharing options...
kewb Posted June 16, 2015 Share Posted June 16, 2015 I hate dealing with insurance. In NJ there are only 3 companies that will issue private plans and they all stink in various ways. When we had amerihealth, a high deductible but reimbursement once you met the deductible plan, they nickel and dimed me so it took until almost the end of the year to meet the deductible. This year I switched us to an hmo because dh's specialists don't take insurance and I would rather have a lower premium so I have the money to pay the specialists. The referral process is a pia. We are fortunate that our primary care doc is not one of those docs who denies sending you to a specialist but it takes a week to get the referral. I just had to get a different referral because the endocrinologist we were seeing stopped taking our insurance. Any time I have to call it is a minimum half hour on hold before you get to a person. There is no way sick people can deal with this nonsense. To the op issue. Billing will just resubmit. The insurance companies just make stuff up so they can delay payment as much as possible. 1 Quote Link to comment Share on other sites More sharing options...
Harriet Vane Posted June 16, 2015 Share Posted June 16, 2015 My beef with UHC is that they will not cover routine chiropractic care even if you have a diagnosed condition. I have scoliosis, bone spurs, arthritis, and a connective tissue disorder. The bone spurs cause my hands to fall asleep. Any doctor will tell you that the more you allow the nerves to be suppressed and irritated like that, the more likely you will have long-term or irreversible damage at some point. Since I value my hands and want them to remain fully functioning, I need maintenance adjustments. (There are other things I do to help maintain the condition, but I don't expect insurance to pay for those in-home measures.) Despite the years of documentation from multiple doctors of multiple specialties, UHC will not cover any chiropractic other than crisis care (like if I were in a car accident). Living in pain and losing function in my hands is not an option, so I pay out of pocket and I curse the idiot insurance company who think they know better than my doctors. Quote Link to comment Share on other sites More sharing options...
craftymama Posted June 16, 2015 Share Posted June 16, 2015 I'm joining in the group hate here! I hate when I get a medical bill so long after services I've moved. I hate it even more when that move required I change insurance. I hate getting the billing information on their stupid web site and then finding out they put the wrong address. I hate getting letter after letter and bill after bill with contradicting information. I hate that no one knows how to pick up the da** phone when they run into a problem. And I especially hate when they answer a question with the whole I can't advise you line or the I can't really answer that or I can't tell you what you should do. No, of course, you can't because I have to play by your rules but you're like a three-year-old changing the rules every five minutes. For the OP, I hope what everyone is saying about them just resubmitting is correct! 1 Quote Link to comment Share on other sites More sharing options...
MyThreeSons Posted June 16, 2015 Share Posted June 16, 2015 They also claim, on our plan, to pay 80% of our medical bills after we've met our deductible, but of course that isn't the way it works at all. They pay 80% of what they feel we "should" have been charged, not what we were actually charged, This is actually pretty standard in health insurance, and has been for as long as I can remember. When you use an in-network provider, the provider has generally contracted with the insurance company to accept the combination of the insurance company payment and your co-insurance / deductible. So you will often see a substantial write-off by the provider. What can really hurt is when you use an out of network provider. Depending on your insurance, they may either not cover it at all (and what you pay may not go toward your out of pocket limit), or they may only cover their allowable amount, and since the provider is not in network, they have not agreed to write off the difference, so you could get stuck with that. And then there is the whole pre-approval issue. For some things, if you haven't received authorization in advance, the insurance company can deny the claim entirely. Quote Link to comment Share on other sites More sharing options...
Lara in Colo Posted June 16, 2015 Share Posted June 16, 2015 I think that the Dr isn't the issue here-- a company that is willingly trashing your reputation is cause for a strongly worded letter from your attorney--- I say this and I hate attorneys with a passion! and I hate jumping to use them when other means can be used-- but this company is ruining your good name with your medical professional--- this practice must be stopped and I would be furious enough to look into a report to whatever agency controlls the insurance world 1 Quote Link to comment Share on other sites More sharing options...
Guest Posted June 16, 2015 Share Posted June 16, 2015 I think that the Dr isn't the issue here-- a company that is willingly trashing your reputation is cause for a strongly worded letter from your attorney--- I say this and I hate attorneys with a passion! and I hate jumping to use them when other means can be used-- but this company is ruining your good name with your medical professional--- this practice must be stopped and I would be furious enough to look into a report to whatever agency controlls the insurance world This is what bothers me. I don't care if it happens all the time, I don't want there to be any hint that I'm someone who doesn't pay her bills!! I take that very seriously! I suppose I could figure out who to report this too but will it matter?? UHC will send an apology letter and keep doing the same crap. 1 Quote Link to comment Share on other sites More sharing options...
Ali in OR Posted June 16, 2015 Share Posted June 16, 2015 Just reading "United Healthcare" in the title raises my blood pressure. They make life more difficult and much more stressful than it needs to be. 1 Quote Link to comment Share on other sites More sharing options...
Word Nerd Posted June 16, 2015 Share Posted June 16, 2015 We just had a claim denied because we didn't return a form our insurance company supposedly sent in March. We never received one, so I find that suspect. Aren't appeals fun? <_< Quote Link to comment Share on other sites More sharing options...
prairiewindmomma Posted June 16, 2015 Share Posted June 16, 2015 Seriously, it's infuriating. My last appeal with UHC went on for over 15 months. They paid $0 of the claim. Quote Link to comment Share on other sites More sharing options...
TranquilMind Posted June 16, 2015 Share Posted June 16, 2015 I agree with all of this. I think the Frustration and Incompetence Factors are ratcheted up to benefit the insurance companies, buy them time, and hopefully (for them) they won't have to pay at all. We've had claims denied because we abbreviated Florida instead of spelling it out. Insurance companies need to be eliminated. Good idea initially that became a greedy monster. 1 Quote Link to comment Share on other sites More sharing options...
LaxMom Posted June 16, 2015 Share Posted June 16, 2015 Insurance companies need to be eliminated. Good idea initially that became a greedy monster.Insurance companies were founded on greed. Baylor decided its hospital was not being filled enough because people didn't want to/couldn't afford to pay the rates, so they cooked up a scheme for hospital care to be prepaid on time. Thus, BC/BS was born. Quote Link to comment Share on other sites More sharing options...
Bluegoat Posted June 16, 2015 Share Posted June 16, 2015 Just remember when it comes time to vote that those of us in countries with universal insurance read these threads with google-eyes. I've only received a medical bill twice in my life, because I decided to spring for a private room when I had babies, and it cost me about $100 each time. 1 Quote Link to comment Share on other sites More sharing options...
Laura Corin Posted June 16, 2015 Share Posted June 16, 2015 Insurance companies were founded on greed. Baylor decided its hospital was not being filled enough because people didn't want to/couldn't afford to pay the rates, so they cooked up a scheme for hospital care to be prepaid on time. Thus, BC/BS was born. Interesting, because the UK NHS was also founded on greed. Before the NHS was instituted just after WWII, doctors relied on the patronage of the relatively few upper-middle class people who could afford to pay them. They often treated poor people pro bono, and their work at hospitals was usually entirely charitable (wealthy people had their operations and nursing at home). So the NHS was a benefit to doctors which overcame any other objections they had, because it meant regular pay for all of their work. In the words of the founding government minister in charge of the NHS, 'I stuffed [the doctors'] mouths with gold' Quote Link to comment Share on other sites More sharing options...
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