Jump to content

Anyone use United Healthcare HMO?


The last post in this topic was posted 5363 days ago. 

 

We strongly encourage you to start a new post instead of replying to this one.

Recommended Posts

It is that time of year again. We need to pick a new HMO. Looking over the material, United Healthcare seems to be a little better than the other choices, but we know nothing about them. We just moved here and my wife has a new job. So we have to make a change.

 

Anyone have something to say about them, either good or bad?

Link to post
Share on other sites

From a provider standpoint: I'd rather put my head in a vise grip on a daily basis than deal with them. They're atrocious, they process claims incorrectly all the time, reps are rude. Any one in the billing field would agree that they are one of the WORST for dealing with, running neck and neck with Cigna.

 

From when I had them: Plan itself was good, when they actually PAID the bills. I spent a lot of time on the phone with them and providers getting claims fixed. I don't know how I'd have done it if I didn't work in the industry.

Edited by cotterpin
Link to post
Share on other sites

I have to say that United has done an INCREDIBLE job throughout my very extended illness. There are things that are a pain, like needing to get referrals for the specialists, and needing pre-authorizations for surgeries, etc. but these are common to HMO's.

 

What has been great as a patient is that most of my providers are linked to them via a computer system, so bills are in AND PAID within a couple weeks. I keep track of everything via the United website, so I know what to expect in terms of co-pay billings, etc.

 

You DO need to watch out on the prescription end of it. My meds are some serious stuff, and because they are not run-of-the-mill, but "tier 1" I end up with a $30 co-pay per prescription, not just the normal $10. For me, that's about $180 a month in prescription co-pays verses $50 a month. (You can get a little cheaper with their mailed prescription program, but once it was stolen from my mailbox, I decided the $5 per was not enough of a savings to continue the mail program.) On the other hand, all my labs have been free of charge to me, and I am at the lab twice monthly!

 

From a patient point of view, they really have been very smooth to work with, including things that are a little out there, like continuing lab work, and ongoing physical therapy. They have never, to my knowledge incorrectly processed a single one of my claims, and I have, literally, hundreds. That said, my primary doctor just told me she is discontinuing her relationship with them because they are apparently, as noted by cotter, a royal pain to deal with from the provider point of view. I haven't started looking for a new primary that accepts them, so I don't know how prevalent the "providers don't want to work with them" is.

 

Hope this helps.

Link to post
Share on other sites
That said, my primary doctor just told me she is discontinuing her relationship with them because they are apparently, as noted by cotter, a royal pain to deal with from the provider point of view. I haven't started looking for a new primary that accepts them, so I don't know how prevalent the "providers don't want to work with them" is.

 

Hope this helps.

 

This situation is becoming more and more common a trend. My current company is one considering not renewing with them due to so many problems and incorrect denials. A good billing department will prevent their patient from even realizing half the fusses we put up with from them.

 

The problem is with them, there is no inbetween. Some patients, like yourself has minimal issues with them, while others have nothing but headaches that require the the threat of reporting them to the Insurance comissioner to rectify.

 

If you have no other choice, they're better than nothing, but if there is another choice, I'd go for them.

Link to post
Share on other sites

I have UHC thru work. It's good healthcare for what I pay, which is $300.00 a month to fully cover me and family. My only problem is, they are SLOW to update changes. My youngest daughter turned a year old in APRIL and I still don't have a card with her name on it. I also keep getting a bill (and yea, it's on my CR) from the hospital, charging me $1200 for her labor and delivery. I keep calling UHC and they keep telling me they'll take care if it, but they haven't yet. =(

Link to post
Share on other sites

Just make sure they have doctors in your area. A company I worked for 4 years ago switched to them and we had no choice. Turns out UHC didn't really know what city we were in and all the approved doctors and hospitals were 5 hours away. After much bitching and 7 months later, they had a pretty good network of doctors in my area but were very slow to pay anything and didn't pay some claims during the time we had no doctors or hospitals. I am still being billed for a MRI that they did not pay even though I have a letter saying that they would. A co-worker's MRI was paid for and then the payment was taken back a year later. Her's is in collections while I keep threatening to sue them so mine hasn't gone to collections yet but probably will sooner or later.

Link to post
Share on other sites

Remember this magic phrase when dealing with UHC:

 

 

 

FIX IT WITHIN X DAYS OR I WILL FILE A FORMAL COMPLAINT WITH THE INSURANCE COMMISSIONER AND ATTORNEY GENERAL

 

 

For those of you wtih current policies, be SURE to involve your HR department and get them involved. They need to know if there are problems, because they have different contacts that may be able to help out.

 

Get confirmation of anything, reference numbers for phone calls, fax confirmations, send anything important via CMRRR. They're notorious for "losing" things.

Link to post
Share on other sites

I had United about six years ago....hated them with a passion....wouldnt insure my dogs with them.... I had a routine surgey when I had them.....out of pocket for me was close to 2K... and yes they are SLOW...VERY SLOW....in like paying hospital bills etc etc... If you love uncertainity and like to pull your hair out...then United it the company for you...

 

Fast forward for the last couple of years...have Cigna... had the same surgey but in a different area..... my cost you ask?? 75 buck co-pay...no questions....

 

Good luck!!!

Link to post
Share on other sites
I need to call them tomorrow before we sign on the dotted line. There is a prescription I take once a year, but it costs $6,000 a dose. UHC lists the price as $57,000+ per dose which is absurd. And it is not clear it is covered.

 

 

What medication are you on?

 

If UHC states anywhere it's not covered it's not.

 

They'll deny your claims over and over and over again stating this, regardless of what they say about covering it. Seen it happen many times with them for items that were "non covered" but that Utilization management or benefits had decided to cover.

Link to post
Share on other sites

The two prescriptions I was worried about were the viadur ($6,000 once a year) and casodex (about $1200 -$1500 four times a year). But I have only been paying a $80 copayment each time I order (once yearly on the viadur and four times yearly on the casodex). What threw me was the United web site indicated the viadur was $57,000 once a year. But I checked and they do cover both medicines with the same copayment as before.

Link to post
Share on other sites

No, I double checked. It is $57,000 a dose according to them. But I will only have the $80 copay. And, I don't get that one for eight more months so I will be able to see how good United is. We went ahead and turned in the paperwork today. At that price, I had to make sure it was covered.

Link to post
Share on other sites

Average Wholesale price (Current) in case you ever need it :)

 

Viadur J9219 $2178.364 per 65 mg dose

 

Pharmacies set the pricing, and it's usually AWP X markup (usually anywhere from 10-25%). IIRC, United will pay the pharmacy AWP x 10%

Link to post
Share on other sites
What are they telling you about pre-existing conditions? Your meds will not be covered if your underlying condition is not covered.

 

 

Shouldn't be an issue as he is covered by a plan right now, HIPAA took care of that issue for 90% of the population.

 

 

This is a pretty good explanation

 

http://info.insure.com/health/hipaa.html

 

HIPAA imposes limits on the extent to which some group health plans can exclude coverage for pre-existing conditions. For instance, if you've had "creditable" health insurance for 12 straight months, with no lapse in coverage of 63 days or more, a new group health plan cannot invoke the pre-existing condition exclusion. It must cover your medical problems as soon as you enroll in the plan.

 

What is “creditable†coverage? It includes prior coverage you had under any of the following health plans:

 

· A group health plan

 

· Medicare

 

· Medicaid

 

· A military-sponsored health care program such as TriCare

 

· Health plans offered by the Indian Health Service

 

· A state high-risk pool

 

· The federal Employees Health Benefit Program

 

· A public health plan established or maintained by a state or local government

 

· A health benefit plan provided for Peace Corps members

 

On the other hand, if you are not switching from a “creditable†health policy when you enroll in a new group plan — or had coverage from a foreign health insurer — your new insurer can refuse to pay for any of your existing medical problems (except pregnancy, if the plan has maternity coverage). Maternity restrictions are only legal for a maximum of 12 months. Late enrollees in group health plans might have to wait up to 18 months for coverage of pre-existing conditions.

Link to post
Share on other sites

I liked them when I had them last year. My doc hated them though. I had her before I changed ins. She told me if I hadn't been coming to her for the past couple of yrs. she wouldn't have taken me in b/c of my ins.

 

I gues providers really do think they suck.

Link to post
Share on other sites

The last post in this topic was posted 5363 days ago. 

 

We strongly encourage you to start a new post instead of replying to this one.

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.




  • Member Statistics

    • Total Members
      180,551
    • Most Online
      2,046

    Newest Member
    meli1979
    Joined
×
×
  • Create New...

Important Information

Guidelines