My insurance carrier is trying to kill me

Discussion in 'Fibromyalgia Main Forum' started by TXFMmom, Apr 17, 2007.

  1. TXFMmom

    TXFMmom New Member

    My husband's company switched to United Health Care last summer, and since that time they have created a nightmare for me. I have SSDI, so I have Medicare, but it is my secondary, since United is my primary.

    I clearly printed that on the enrollment form. However, United claimed, wrongly, for the first three and a half months, that they were the SECONDARY, rejecting every claim, refill, etc. and sending me a mound of stuff, while Medicare said, oh no, we are not primary we are secondary.

    I called and gave the information to United a total of THIRTEEN times, asked them if I needed to fax it to someone, etc. Every time they said, oh no, everything is corrected and it WENT ON. They interferred with appointments, when docs tried to confirm coverage, kept me from getting badly needed tests and things and CARE.

    One doctor threatened to drop me as a patient.

    I finally called and told them that I knew their address and I was going to come up there. No threats, just that I was coming. THEY REFERRED ME TO A RESOLUTION PERSON, who then, finally, got that corrected. They had driven me to tears and despair. I think they finally did it because I told them that I had spoken with the Medicare coordination of benefits office and THAT THEY TOLD ME THEY WOULD LOOK INTO THE MATTER AND THAT IT WOULD NOT BE PRETTY FOR THE INSURANCE COMPANY.

    However, THEY HAVE QUESTIONED EVERY CLAIM I HAVE HAD...I MEAN EVERY ONE. They rejected a claim for my husband, after giving prior approval, for testing for carpal tunnel, AND I CALLED THEM AND TOLD THEM I WAS AN ADVANCED NURSE PRACTITIONER AND I WAS CALLING THE INSURANCE BOARD because their phoney reason as NOT AN ACCEPTED MEDICAL TEST AND NOT MEDICALLY NECESSARY WAS TOTALLY BOGUS, AS THEY HAD BEEN TESTING IN THIS MANNER FOR THIRTY YEARS. They reviewed it and paid it.

    I had 94 letters, inquiries, rejected payments, and paperwork from them and I was unable to decipher what, who, and where. Finally, I had to demand dispute resolution again, and we spent 45 minutes walking through everything and seeing what they had paid, how much, and what remained in the way of claims. THEY HAD TROUBLE TELLING WHAT FROM WHAT.

    Then, I received letters on virtually every claim requesting if it was due to some accident, mishap, or something which could be palmed off on SOME OTHER INSURANCE, AS IN AUTO, WORKMAN'S COMP, ETC. How can a sinus infection be due to an accident? THIS IS HARASSMENT.

    I called the number to give the answer and an INDIAN AS FROM INDIA ANSWERED. I DO NOT LIKE ALL MY INFORMATION BEING GIVEN TO PEOPLE IN INDIA, AS THEY HAVE NO LAWS ABOUT PRIVACY AND THOUSANDS OF PEOPLE HAVE HAD THEIR IDENTITIES AND CREDIT AND THINGS COMPROMISED OVER THERE AND THEY DO NOTHING.

    Anyway, this woman wanted to know if I had an accident which caused my back pain. I told her that it was degenerative and that the accident HAPPENED FIFTEEN YEARS AGO IN MY SHOWER. She then asked me if that shower was in my automobile and had I had an accident in it. I told her that the shower was IN MY HOUSE, AS IN BATHING, AS AMERICANS BATHE in their home in showers. She kept insisting did it happen in a car? I LOST MY TEMPER AND TOLD HER THAT IT WAS NOT MY FAULT THAT SHE WAS STUPID AND DIDN'T UNDERSTAND AMERICAN ENGLISH AND THAT I HAD MADE IT QUITE CLEAR TO HER THAT THE SHOWER WAS IN MY HOME, THAT IT HAPPENED FIFTEEN YEARS AGO, AND THAT NO OTHER INSURANCE COULD BE MADE TO PAY IT AND THAT I BETTER NOT GET ANOTHER INDIAN ON THE PHONE WHEN I CALLED BACK THE NEXT TIME.

    How can they expect us to call these idiots, from a country 10,000 miles away and discuss private, medical things with them, and they have all our info, which they should not, and they dont' know what a damn shower is?

    Now, I have started having chest pain, and we cannot determine whether it is cardiac, but my cholesterol has gone up, I have developed type II diabetes, and it should be checked out. I called the cardiologist, his nurse called to triage me, and we came to the agreement that I had to have all the labs done again, and that I should have the cardiac cat scan, which is wonderful and so accurate, and NOT PAINFUL OR DANGEROUS. I had the nuclear stress test two years ago, and I tell you it MAKES YOU FEEL LIKE YOU ARE DYING AND I WAS SICK FOR THREE Days.

    She warned me that some insurance carriers will not pay for it, despite THREE EXCELLENT STUDIES HERE AND IN EUROPE saying it is the BEST FOR DIAGNOSIS. IT ALSO COSTS $1,000 compared to $2,500 for the nuclear and THEY WON'T COVER IT.

    Medicare DOES COVER IT, BUT REFUSES TO PAY FOR MINE, BECAUSE UNITED WON'T COVER IT. That strikes me as being UNFAIR TO ME, BECAUSE I PAY FOR THE SAME MEDICARE PREMIUM AS THOSE WHO ONLY HAVE MEDICARE.

    She called back, said they wouldn't let me have it, so we had to go with the nuclear test. She then called back and said THEY ARE REFUSING THE NUCLEAR AS WELL. I exploded.

    I have to go in and see the doctor, who then can order it and they may or may not give permission for it, sit in the office, wait for the approval or rejection, and then have the test, if possible, then wait to see him when it can be read. I am diabetic and they cannot see me till 12:30, and I CANNOT EAT, AND THEN THEY MAY NOT BE ABLE TO DO THE TEST TILL 2:30 AND I may not be able to see him until 4:00 to 4:30.

    I am going to call my representative and Senators tomorrow to complain about Medicare, but I AM CALLING THE LOCAL TV CHANNELS TO TALK TO THEM ABOUT UNITED.

    To take the cake, I read in MONEY Magazine that they conducted a study on rejections of legitimate medical charges and claims, and that UNITED REJECTED LEGITIMATE CLAIMS, REQUIRING FIGHTING, 14.3% OF THE TIME, AND THE NATIONAL AVERAGE WAS ONLY 4.3%.

    Then, I read that AARP is developing an insurance program for people in their 50's and 60's to cover them when they can't get coverage, before they qualify for Medicare and THEY ARE USING UNITED HEALTH CARE. THEY HAVE NO IDEA.
  2. lynnintn

    lynnintn New Member

    My mom is an insurance biller (X 20 years) and says United Healthcare is the WORST to deal with, even worse than Medicare. Right now I have Humana, which is not bad, but I will be paying it through COBRA after my divorce.

    I am so sorry @ this insurance situation. It is so very overwhelming, I cannot even think of anything advice except to call your state insurance regulation dept.They are trying to wear you down by denying all of these claims and I certainly think they are good at this little game. They are a bunch of greedy SOBs (all of the insurance companies, some just worse than others).

    I am eager to hear what your congressmen and local TV stations have to say!

    Lynn in TN
  3. fivesue

    fivesue New Member

    I believe that to be an oxymoron....We had them for several years through my husband's work, and they were the worst...paid the worse, questioned everything. I was so relieved when the company went back to Blue Cross.

    I'm so sorry that you have had all this problem. I pray that you will get all this worked out. My thoughts and prayers are with you.

    We also need to contact AARP and let them know the reputation of UHC.

    Sue