Complaint / review text:
The main problem is getting them to pay legitimate claims, and fill mail-order prescriptions properly. As of this writing, they have omitted 6 claims from the December claim summary, that were out-of-pocket claims throughout the year, that were submitted by me and applied to the deductible, totaling $732.14. This changed the total amount of the end-of-year deductible, to be less than it should be. Therefore, I was charged extra for prescriptions that should have been covered 100%.
I was denied full payment of diabetes test strips on September 27,2011, for an out-of-pocket expense of $540. UHC only applied $289.95 towards the deductible. Two other claims prior to this one, were eventually applied towards the deductible, but not until they made me submit the claims numerous times. After the first denial claim, I followed up with two appeal letters, and they now are requesting me to start all over again. The name of the person who sent me a letter on January 6,2012, requesting this, is Betsy, director of customer service. There was no address, and no contact information.
UHC denied payment to Naples Physical Therapy for services rendered, beginning November 1,2011, because the provider's authorization was not filed on time. I asked UHC if it was an oversight, and if the provider filed right away, would they please allow payment, and they said, yes. Also, payment to Dr. On December 21,2011 was applied to deductible, although the deductible should have been fulfilled, and payment made to the physician. The doctor is owed this money by UHC.
As a result of UHC removing the entries of the claim summary (I have a computer copy of the month before where they were entered properly), it changed how they paid the claims. The month of December was a disaster, when Medco had 3 major problems out of 4 prescriptions. It took me about 20 hours on the phone to get it right. All I want is for UHC to follow their contract, and not deny claims because they hire untrained representatives. They required way too much of my time, to process claims that should have been automatic!