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Health Insurance Complaint: MultiPlan Billing

08/23/2012

Insurance companies are charging higher and higher premiums for their health insurance but they keep paying less to the health care provider. I have received multiple faxes from MultiPlan wanting me to receive 1/3 less than my fee and in return they will sent me a check within 10 days of receiving my fax. I could be wrong but I don't think I am. I think MultiPlan is sent up by the insurance company to send out these faxes in order to save money for the insurance company in order to increase their profits. They in no way intend to pass this savings on to their customers, instead the insurance companies want their premiums but they certainly don't want to pay out covered medical for their customers. They want to weasel their way out of not paying the doctors.

Sometimes when they receive claims or appeals they "never received the papers" and try to make it hard for the patients and the doctors hoping we would give up the appeal or claim. Sometimes they receive one claim and not the other even though the 2 claims were sent together. Always sent mail certified return receipt so they can't say they never received it.

Something to think about!!

 
Health Insurance Complaint: Humana Family Insurance

07/02/2012

I pay $1048.00/mo in premiums for a family of three. The coverage is $5000.00 deductible for each member of the family with $25/$55 co-pays. Anything performed in the office other than what is considered preventative care by Medicare is not covered until your deductible is met. The plan includes RightSourceRx. When I order my levothyroxine (90 days) through RightSourceRx, it cost $25—I can get the same prescription filled at Wal-Mart for $10 not using insurance. I also take ranitidine 150 mg twice/daily that RightSourceRx charges $16.00 for 90 day order and I get the same from Wal-Mart for $10. To get a Humana representative on the phone takes an excessive amount of time, average 15 minutes plus. To get a representative that knows up from down may take five tries. We just changed to Humana—The absolute worst insurance rates and service I’ve dealt with in my 40 years of having health insurance!

Best regards,
Phil Thompson

 
Health Insurance Complaint: Aetna Health Insurance

03/19/2012

People need to know. Please post this review of Aetna Health Insurance. I have been denied too many times; I'm not going to wait until I have a major claim to be denied again.

If you think for one second that Aetna will pay claims, you are sadly mistaken. Go ahead and pay the cheap premiums. Go ahead and think you're covered when you're not. Aetna will play games with words, exploit fine print and petty excuses to DENY every penny of your rightful claims. YOU'VE BEEN WARNED!

Overall rating = 0 out of 10, 10 being highest.

 
Health Insurance Complaint: Aetna Dental Insurance

08/20/2011

Hello,

My 2nd appeal with Aetna Dental was denied.  This case does not involve a lot of money but it is a case of principal and may affect other patients as well.

In April 2011 - My Son’s dentist recommended he get 4 sealants. She also recommended that ahead of the treatment I should verify insurance with Aetna Dental.

1) I checked Aetna Dental website and it said sealants are covered
2) I called them and they said sealants are covered
3) I even requested a written ‘pre-determination’ of benefits – which also stated that treatment was covered.

As soon as school let out in early June 2011 – I had my son get the sealants. When the claim was submitted to Aetna Dental it was DENIED because of his age. He turned 15 on May 17, 2011. Benefit expires at age 15!

Nowhere did Aetna ever mention on their website, on the phone or on the ‘Predetermination of Benefits’ that I received in early May that this benefit will expire in less then 2 weeks (aka at age 15). Had I known I would have had done it sooner.

Both my Aetna Appeals were denied – on the basis that:

1) I should have checked a booklet (which I did not have)
2) The above 3 checks I had done with them are not a guarantee of service.

My issue with Aetna is that they should have stated that benefits expires at age 15 and they NEGLECTED to do so, therefore the claim should be covered.

Will you post my Review?

Sincerely,
Trace Gouws

 
Health Insurance Complaint: Anthem Blue Cross Blue Shield

06/06/2011

If you have a choice in insurance providers, I would NOT recommend ever using Blue Cross/Blue Shield/ Anthem. Our employer gave us no option except BC/BS last year during our annual enrollment in November, 2010. At that time, we were given only a summary of benefits, nothing specific. When I requested a copy of our specific coverage, I was told it would not be available until the first of the year, 2011, but it is "very similar" to the plan we had previously through United Healthcare. Well, as of today, June 6th, 2011, we are still waiting on a specific "Explanation of Benefits" or a "Summary Plan Description". I am told it is being reviewed by legal and is still not available. In order to find out exactly what is and isn't covered, we must call the company each time. I asked what happens when we have a dispute on coverage, since we have nothing in writing and was told "I think those calls are recorded so we could go back and see what you were told on the phone"!!! In other words, if there are any disputes, we, the customer, are screwed. Also, today, I was told a recent claim was denied because the provider was not in the network. This bill was for labs sent in for testing by the network provider I went to, but I am told they sent the labs to a non-network provider and that's my problem. I am the one responsible for making sure the network doctor I go to, uses the proper testing/lab facilities! Kind of hard to do once I walk out their door. Insanity!!

 
Health Insurance Complaint: Anthem Blue Cross

04/14/2011

After coaxing from my wife and friends I finally for a Physical Exam. Well, the Doctors office claimed that Anthem Blue Cross denied coverage even though my plan has 100% coverage for physical exams. The Doctors office wanted immediate payment so I paid and said I would take it up with the Insurance. That was my big mistake. Since then Anthem Blue Cross has told me just about every excuse why they can’t pay me:

  • The doctor used the wrong charge but would not tell me anything else. Repeated attempts by the Doctor office with various codes yielded same result, no payment.
  • Once the doctor did get an appropriate charge code Anthem told me: Please wait 30 days while the claim is being investigated
  • 30+ days later when I called them: “Not sure what happened, I will resubmit, please call again in 30 days”
  • Another 30+ days: “yeah, sorry, the claim is now being processed, please call again in a few weeks”
  • Another 30+ days: “Hmm, not sure what happened, oh the claim was flagged as fraud since it already was in the system, I will now expedite payment”
  • Another 30+ days: “The claim was rejected since you asked for payment but we can only pay the service provider, let me re-instate the claim”
  • Another 2 weeks: “They are working on it, let me see if I can get it expedited”
  • Another 2 weeks: “Not sure what is up, this is a mess, call again in 2 weeks”
  • Today: “Let me discuss with a supervisor and see what is going on. I see lots of notes. I do apologize. I will get another lead to expedite it. Call next week and it should be done.”

Lesson learned: Don’t go with Anthem. They spend all their money on nice web pages instead of customer service/ claim processing.

 
Health Insurance Complaint: TRICARE PRIME

04/14/2011

My family is currently on TRICARE PRIME REMOTE. This plan is for active duty service members stationed more than 50 miles form a military treatmentfacility. If all you need is routine care it is adequate. The problem arises any time you stray from routine care. For instance: during my wife's pregnancy with our 2nd daughter, she had many complications and our daughterwas born premature. The bills for office visits were paid, but when she went to the doctor's office having contractions (month 5,6,7,8), and the doctor sent her to the hospital and for ultrasounds, the bills were not. Seems that TRICARE only sees the necessity for 1 ultrasound per pregnancy, after that it's the service members responsibility. So if you're on tricareprime remote I wouldn't plan on having any children unless you have a few thousand in the bank to pay the bills.

 
Health Insurance Complaint: Mutual Of Omaha

03/29/2011

I and my wife each signed up for Medicare supplemental insurance with United of Omaha (a subsidiary of Mutual of Omaha). Its rate was the lowest in my area last year. Effective January 2011, our rates were raised by 20 percent. Now in March we are again informed that our rates will go up another 18 percent. Together the increases now amount to 41.6 percent over last December's rate.

I am now convinced we were offered "teaser" rates to get us on board. Now that we are here, Omaha is jacking up rates mercilessly, thinking that inertia will keep us here. I suggest that prospective customers keep this behavior in mind when shopping for rates. The lowest initial rate is not always the least expensive in the long run, if you are dealing with a company which is ethically challenged.

 
Health Insurance Complaint: Blue Cross Blue Shield

03/26/2011

I truly hope that this message makes it to at least one person who is considering purchasing BCBS health insurance. If I can help one person avoid the headaches that have resulted from dealing with this company, it will be worth the time I took to submit this review. BCBS is a deceptive, dishonest, manipulative company that couldn't care less about members' healthcare as long as they collect the premium each month. They will raise your premium and simultaneously deny more and more of the claims that they are responsible to pay. You will pay unbelievable premiums each month, and most of the claims (be it routine office visits or prescriptions) will be denied. Trying to reach customer service is almost impossible and, when you do, you will be given a vague and nonsensical answer with no resolution. You will be left with a simple response..."no exception." Take my word - if you are considering BCBS as your health insurance carrier, reconsider.

 
Health Insurance Complaint: Orthopedic Not Covered

11/13/2010

To Whom It May Concern,

I am looking for an Insurance that is not limited to the doctors in my area or state. I travel between NY and CA often throughout the year because of my work and there have been times when I need to go to a doctor in CA, but because I am a New York resident and my insurance company is an HMO in New York, I can only benefit from an emergency room visit, yet must pay for any subsequent doctor visits. Your website relayed a story of "how to know your coverage" and gave the example of a broken ankle. Funny enough, that's exactly what happened to me. I broke my ankle playing tennis in CA and went to the emergency room, which was covered by my insurance. But the next 12 weeks of orthopedic follow up visits had to be payed out of my pocket. So, in essence, it turned out to be a very expensive tennis game!

I would like to know if there is such an insurance that covers a person regardless of where you are in the country. I would imagine that there are many people who have multiple domiciles or who travel a lot. They must have this same predicament. Perhaps there a supplemental insurance that I can get just for CA (although every time I go to get a quote, it asks for your state of residence so it defeats my purpose).

I want to have the ability to choose my doctors, as well.

Can you shed any light on this for me.

Sincerely,

Victoria

 
Health Insurance Complaint: United Healthcare

06/30/2010

I just read an article that says, “Hospital executives rank United Healthcare as the worst insurance company in the United States.” (It is available here: www.allbusiness.com/health-care/health-care-facilities). This will come as no surprise to many members and providers alike. Like many others, I want to share my recent experience with United Health Care so that people can decide for themselves whether or not this is the kind of health insurance they feel they want to purchase for their families.

I am a neuropsychologist and was asked to see a UHC member for neuropsychological testing. I filled out all of the appropriate forms required by United Healthcare and received a telephone call authorizing me to test their member. They gave me a cap on the hours (13 hours total) and an authorization number. I provided the services as promised and then sent the appropriate claim to the United Healthcare offices. When they sent me the check, there was a note on the Explanation of Benefits saying I had agreed to a discounted fee (an approximately 50% discount, mind you) through an organization called MultiPlan (If you haven't heard of them, you're in for a treat. They contract with insurance companies to try to persuade clinicians to agree to a reduced fee and they get paid a percentage of what they "save" the insurance company.) Needless to say, I do not and never will have an agreement with this company, as I do not support business practices such as this.

When I contacted United Healthcare to straighten this out, they told me I had to deal with MultiPlan. Multiplan never answers their phone (I wonder why) so I got nowhere until I filed a complaint with the Better Business Bureau. This got the attention of Cindy Hernandez, a Consumer Affairs Advocate for UHC (1-800-842-2656). She researched this issue and came up with a fabulous solution! She decided that United Healthcare had authorized this treatment in error and paid me in error AFTER I HAD RENDERED THE AUTHORIZED TREATMENT to their member. They then "recalculated" the claim form and decided that I actually owe THEM money! They have asked for the entire amount back ($966.68). They have a very fancy way of explaining their "logic" and have added that the original error was with their processor and they have arranged for her "to receive additional training or other intervention as appropriate."

With a second patient, they attempted to get me to accept a reduced fee through MultiPlan for another member and I declined. After that, they refused to pay me AT ALL for the services I provided to the other member while he was in the hospital. United Healthcare also authorized these services and the correct authorization number was submitted with the claims.

In both cases the services were requested by a physician and approved by United Healthcare. The services were rendered as authorized and the appropriate claims were filed. Unfortunately – and this really is the sad part – both of these claims will have to be paid in full by the members. These claims total thousands of dollars.

As I'm sure many of you know, United Healthcare is the focus of a Class Action Lawsuit in New York because of their questionable business practices. When I Googled “United Health Care reviews,” I was SHOCKED at the number of complaints against this company. How is it that they are getting away with this kind of behavior?

 
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