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HEALTH PLANS: Hey, wasn’t UHC supposed be nice now?

Having been the first health plan to say that it was going to stop hassling physicians back in 1999, I thought United was supposed to be behaving itself and promoting love, flowers and puppy-dogs all around with its providers. (Well apart from that quality ranking stuff in St Louis). Well apparently the answer is not exactly not exactly:

The Arizona Department of Insurance on Friday ordered United Healthcare to pay civil penalties totaling $364,750 — the largest fine in the department’s history — for violations of state insurance laws. State regulators said United Healthcare illegally denied more than 63,000 claims by doctors without receiving all of the information needed to accept or deny a claim. The company also failed to follow state laws for promptly notifying doctors and patients about about decisions and appeals, the state said. United also violated a 2002 agreement to correct previous violations, the state said.
Just a word of warning to the payers that the providers are ready to step it up, just in case you’ve got any ideas — like say insisting on proper documentation, or rewarding for quality (and punishing for the lack of it). And that if you’re going to throw stones, better make sure that you don’t live in a glasshouse yourself.
 

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Randy LongREVIEWpamGeneMr E Recent comment authors
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Randy Long
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Randy Long

can anyone help-uhc without my knowledge has started to deny claims on my wifes healthcare saying because she is ELIGIBLE for medicare, they will only pay as a secondary provider. My wife was covered by uhc for 2 years prior to my retirement from ups and 4 years since. They have even gone back and back billed the providers they had paid last year. An appeal was filed, over a month ago, still no response. On the monthly statements they are showing that medicare is paying the bill and they are paying as a secondary provider and she does not… Read more »

REVIEW
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REVIEW

FEDERAL JUDGE SAYS IF THEY DID NOT PROMISE OR SIGN ANYTHING, KICKBACKS ARE OK??? WHICH IS NOT TRUE BY THE WAY. Turning next to relators’ claims based on alleged violations of the Anti-Kickback Statute, the court concluded relators failed to allege “that United Health certified compliance with the Anti-Kickback Act, nor did they allege that such compliance was relevant to the Government’s funding decisions.” The court then declined to exercise supplemental jurisdiction over relators’ state law claims and refused to grant relators leave to amend. MEDICARE FRAUD, MEDICADE FRAUD, AND KICKBACKS AND BRIBES BUSINESS AS USUAL,INSIDER INFORMATION GIVEN. 9B BS… Read more »

pam
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pam

After assisting many employees in my former position in Human Resources battle with United Healthcare over benefits they were entitled to, I find myself in need of assistance. UHC has denied claims stating: Provider did not submit w/in contract time. That was untrue so the next denial explanation was : Proof of timely filing was needed. That satisfied they stated coverage was not in place at time of service. Proof of coverage was submitted; they stated on the phone they would pay. The collection agency received documentation of this acknowledgment. Yes, it took this long. More than a year later,… Read more »

Gene
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Gene

I have been with MDIPA for over 15 years and I had no problems with them. However this year United Health Care took over MDIPA. Now the problems begin. They call to see if I have another insurance company. They deny claims, the Co-Pays are out of sight, the cost of perscriptios have doubled. I have a procedure scheduled and I found out last night my Co-Pay is $150.00, I called UHC, they said it is spelled out in my new Policy on the last page of a 20-30 page contract!I should have done some home work before I signed… Read more »

Mr E
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Mr E

I’m with you if any one wants to fight them. I suggest we bombard the call center with calls day and night until they have to pay some claims. They lie so badly, never return calls. Then they tell you to appeal it. I am bypassing the appeal and will call every day until they pay. The people there would get so sick of talking to the same people everyday, they might pay the bills theirself. It’s time to fight back- they can hang up on us, put us on hold, then we can call and do the same until… Read more »

Joan
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Joan

UHC is unbelievable. They harass my providers with constant demands for more information and recently, when I checked with one of my providers, they had not received any request for more information. This is for a bill of $800. In one instance they actually called another of my providers and asked…on the telephone…what her phone number was. So far this year I have received no payments, the only communications I have recieved are “requests for more information.” Or they have ignored my claims completely. What are they doing with all this money my employer and I pay for my insurance?… Read more »

Jill
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Jill

Amazing. One of the big-box home retailers that I recently began working for, with the initials “HD”, told me that I could sign up for Health Insurance, even if I only worked 12 hours a week! The provider? United. This morning, I was blessed to see the commercial promoting the new Michael Moore movie…Sicko… and United is mentioned in the 15 second “Blipvert!” (Yeah I almost exploded when I saw that) I reside in Massachusetts and a law was passed by Gv. Romney (who’s in the presidential race – sorta) mandating all residents to be covered by health insurance. What… Read more »

Jim
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Jim

UHC has many ways to deny claims. Remember if your insurance is provided by your employer as part of the the health and welfare plan, then UHC is only the administrator and exempt from state law. The only way to get payment s for services may be to sue your employer. Also it appears in my market that the big discounts that are negogiated by UHC actually go right to their bottom line. Your copay should be based on the amt after discount, but what they do is obtain an illegal kickback without applying the discount to lower the co-payment.… Read more »

bob
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bob

United Health Care has been playing games with my claims. Everyone has been denied. They are using this tactic to make more money for themselves. If you are thinking of buying UHC insurance don’t.

Rodney Craig
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Rodney Craig

United Healthcare- I think they should pay the administrative cost for their errors when they become excessive and “abusive to the system”. In September of 2006 United began paying my claims at 100% of billed charges. To NO avail every claim had to be appealed and request that the process at the contracted rate. All of the first appeals show that they paid correctly and to keep the monies. If I were not an honest guy I would have done that and let them find these on their own. 6 months a 300+ claims later they started pricing the claims… Read more »

Julie Duquette MD
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Julie Duquette MD

UHC has slashed my physician pathology laboratory fees almost 50% compared to two years ago, they are now paying me LESS than HMO rates for PPO patients (they say it’s my “contracted” rate, I never got an updated contract with those reduced fees; when I saw what they are now paying, I felt like I had been kicked in the gut…) AND, over the las two years, they have continually denied claims, and/or failed to process claims correctly; what recourse do we have, I have written the State insurance commissioner (California)–how are we physicians with a small business supposed to… Read more »

David Ta
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David Ta

Is it true that this past Friday UHC let go of ALL Pacificare’s Individual and majority of the Small Group Sales force? How are members being supported?

hcgeek
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hcgeek

First time commenter – but just experiencing deja vu – it seems United has had this problem for years – they’ve been nailed for denying claims without sufficient information before – and almost had selected HMO operations shut down due to this in some locations…the claims systems were highly efficient – but often wrong.

Tom Leith
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Tom Leith

You got space in your exam rooms for a puppy? I bet it relaxes the patients…
And don’t worry, Subtle Sally will get it. She’ll see improved cash flow immediately. There will be great rejoicing. But she will chase you down to get those forms filled in right before the end of the month.
t

G. Hinson, MD
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G. Hinson, MD

Tom, it cost me a 20% increase in overhead just to read and understand what it is you’re proposing. Way too complex. Remember the KISS principal! I’m with Matthew. Just bring on the puppies.