My wife went for a regular GYN checkup on February 3rd, 2011, which included some standard tests, conducted by LabCorp. This resulted in three unpaid bills:
- Dr. C’s bill was for $242.68
- First LabCorp bill for $830
- Second LabCorp bill for $245
In response to the above claims, on February 28th (almost one month later!), United Healthcare sent us a standard pre-existing conditions questionnaire, a letter asking for the names and contact information of all doctors whom my wife had visited between 10/1/2010 and 10/1/2010. Yes, this is just one day. I called UHC and asked about an explanation. They said that there was a computer error when the letter was generated and they would send a new one. So they did.
The new letter listing correct dates (time frame between 6/12/2010 and 9/12/2010) arrived a couple weeks later leading to further delay in re-processing! My wife and I filled it out and sent it as soon as possible (I didn’t keep a copy so I don’t have the exact date).
I didn’t receive any further correspondence and didn’t feel I needed to call them since I had nothing to worry about. My wife had no pre-existing conditions so, as far as I was concerned, the problem was solved and the claims should have been paid. Not really!
I received a letter (sent April 18) from LabCorp, explaining that I owed them $839 because UHC had denied the claim.
I called UHC to inquire about the reason for denial. The representative explained that United Healthcare COULDN’T prove that my wife DIDN’T have pre-existing conditions! Obviously this is a good enough reason for denying claims which UHC doesn’t feel like paying!
This is where the whole show begins!
I asked why UHC couldn’t prove that my wife didn’t have pre-existing conditions. The answer was that UHC had never received the letter we sent them. That same letter which listed all doctors whom my wife had visited during the time period in question. I told them that I DID send it. The representative went quiet for a minute and said “Now I see it!” So unless I confirm that I did, that letter will never see the light of day? The representative explained that, they would send letters to all doctors (Dr. McD. and Dr. C.) asking them about my wife’s medical history and any possible pre-existing conditions. “Ok”, I thought, “maybe now UHC will figure things out and fix the mess”. Little did I know!
Another month passed without any sign of progress. After receiving another letter from LabCorp, dated May 23rd, I called UHC again to inquire what was happening with the claims. I was told that letters were sent to all doctors and none of the doctors replied! OH REALLY!
I called the doctors, the doctors said they had not received any letters from UHC! UHC’s reps kept repeating that they aren’t receiving anything either! I had UHC resend the letters to my wife’s doctors, which was a whole story of its own!
Me: Can you please resend the letters?
UHC rep: No
Me: Why can’t you resend them?
UHC rep: I’m not responsible for sending letters!
Me: Can you please forward me to someone who is?
UHC rep: No
At this time I got seriously pissed off and probably screamed at them until they REMEMBERED how to resend the letters and letters flew out!
This time around, I received carbon copies suggesting that the second wave of letters were indeed sent on May 25th (over 3 months after the GYN visit). That’s all great but the next week I call the doctors as well as UHC again and no one has received anything from anyone! Just CRAZY!
I managed to get the UHC rep to give me a phone number which the two doctors could call in order to learn where they can download the letters online, fill them out and then send them through regular mail. WOW!!! The Internet Exists! So doctors can actually download and fill out these forms online? Why the hell am I going through regular mail which obviously isn’t working???
The result was interesting!!! Dr. McD. called me back saying that, after she called UHC, they CONFIRMED that they actually received the letter from her office on May 27!!! Surprise, surprise! How is it possible that before getting a call from the doctor, UHC refused to have received anything?! Such a SCAM!
Next, I received two more carbon copy letters, dated June 14th. Something was different in them. They were addressed only to the doctors’ last names and first name initial. No address or phone number was mentioned and the last names of these doctors were completely unknown to my wife and myself. They were addressed to Dr. D Kwai and Dr. D Lyons. These new letters gave me NO WAY to contact the doctors in order to get things moving! Coincidence?
I called UHC immediately to see what was going on. The representative I spoke to DENIED to be seeing any information about such letters or doctors being sent. I said… “Ok, then why do I have these carbon copies in my hand?” The representative repeated that they had no idea what these letters were. I decided not to bother with that since I had bigger issues.
I still had no idea what to do about the letter to Dr. C. The doctor just NEVER received the form. Suddenly I got an idea! I went to Dr. C.’s office with my carbon copy, which was addressed to her, had her fill it out and send it. Yes! That worked and UHC got their second letter. Just as the representative was about to say that she is ready to get my claims re-processed, she said, “actually, since Dr. C. and the establishment she works for have different IDs, I will still need to send a letter for pre-existing conditions to the establishment and wait for a response” OMFG!!!! I was about to freak out, when she continued… “I am not sure we really need that; I’ll call you if we do!”
I did not receive any phone call so I thought everything was fine… Not quite!
I called UHC again in the beginning of July, after receiving another letter from LabCorp, demanding immediate payment and threatening to place a negative record on my wife’s credit report. UHC informed me that they have everything except for the two responses from Dr. Kwai and Dr. Lions!!! Wait a minute, I had asked about those two letters specifically and the rep LIED that they knew nothing about them!!!
I called UHC again and requested the information of these doctors. All I was given were two phone numbers, no full names, no name of establishment, no address!
After calling both numbers, it turned out that my wife had received a referral to C. Radiology, which both numbers belonged to. My wife never used that referral but that didn’t stop UHC from continuing their show!
Naturally, during my first call with C. Radiology, they said they hadn’t received anything since they had no record of UHC’s letter, which contained NO explanation about what is requested and why! The people at C. Radiology thought it didn’t concern them and was probably issued in error! I called back UHC and requested a fax number where C. Radiology could fax the letters (two letter, one for each doctor) in order for them to be processed quickly. I also got a reference number # C11401406077260. I called the radiology back with this information and faxed them my carbon copy letters so they could fill them out and fax them over to UHC. When they saw the letters, they remembered that they had already replied to these letters, saying that my wife never visited the establishment. The billing manager was also kind enough to follow my request and re-send the response, over fax, listing that reference number above.
Receiving a fax takes time… for UHC it takes a week!
I called UHC on July 25th. The representative was surprisingly nice! She said that she now had all the information required and she would send the claims for re-consideration. She also said that the claims would be processed within 10 business days!!!
I THOUGHT I HAD WON!!!
Are you ready for this? NOT REALLY! I received a call from UHC on August 4th. The rep was super friendly, she said that she was calling to inform me that THE CLAIM (singular) was being processed and apologized for the whole delay in the process. THE CLAIM??? I have three claims! What was she implying? I got all worked up immediately! I asked “what claim are you calling me about?” She replied that it was that one claim from Dr. C… that’s NOT the one going into collection!!! That’s the smallest claim of all three, which probably won’t be fully paid anyway, even after re-consideration, because some activities during a GYN exam aren’t covered by UHC! I asked about the other two claims. She said she cannot discuss anything other than the claim she was calling me about and that I had to call the main UHC number in order to find out.
So I did! Guess what the response was! “We haven’t received the responses from Dr. Lyons and Dr. Kwai.” I went completely nuts at this point… After all, I DID call UHC the previous week, with that long reference number above, and they confirmed that they had all required information!!! WHAT ON EARTH IS GOING ON?
I gave them the reference number again, this time the UHC rep said they hadn’t received ANYTHING with that reference number on it… IT WAS GONE!
At this point I realized that no matter how many times I send them letter and faxes, they would never verify that my documents were received…
After telling my whole story to the human resource manager who got this “INSURANCE PLAN” in the first place, he suggested that I talk to the insurance agent who arranged the plan for the company.
The insurance agent solved my problems in ONE WEEK!!!
It turns out that insurance agents have direct access to United Healthcare’s online portal. It took me 2 DAYS to get the doctors to send ALL letter to the agent, she entered them into UHC’s system WITH A CONFIRMATION CODE, one week later I called UHC’s rep and they confirmed that the claims ARE BEING PROCESSED, gave me the co-pay amounts I’d have to pay, and the story was over!
If you want to fight United Healthcare, YOU WILL NEVER WIN ALONE!
UNITED HEALTHCARE DESERVES NOTHING BUT TO BURN IN HELL!!!