Let's get rid of United Health care

I recently purchased new glasses and sent the claim letter for $100 hardware reimbursement to UnitedHealthcare SR. As it's been over a month, I called to see about my check.  The customer service rep told me they didn't received my letter/claim and to resubmit.  Funny how they never got my letter, but they sent me paperwork denying my claim.  

As a marine lab student, I'm glad that Duke is working with SR to provide more physicians.  However, between the lack of providers and terrible customer service, I'm not sure this is the right company for our insurance.

I too have had a TERRIBLE time with this new plan. I absolutely despise it. As another student mentioned, I too have had to pay out of pocket for cortisone shots (that used to be covered by BCBS) because they are considered "surgery." Can you believe that? 

Also, prescription drugs that used to be covered without any problems now have to be reviewed before they can be approved. Ridiculous! I would like to spend more of my time working on my dissertation and a lot less of it fighting with the insurance company & going back and forth between my doctors, pharmacist, etc.

My wife and I -- both graduate students -- have had an awful experience with UHC, and we would love to participate in any efforts to return to BCBS.

Could you confirm that it was the Women's Birth and Wellness Center in Chapel Hill that you found to be in-network? I am being told that it is out-of-network, so that information would be really helpful to me.

Thanks!

 Patrick

pmm21@duke.edu

Does anybody know if the cortisone shot policy will be changed next year??  I had to cough up a ton of money in november, because united health considers shots to be "surgeries" (even in this post-modern age of re-interpreting everything this seems like a stretch).  I need another shot, but can wait until September, if the policy does in fact change, as I was told it would by the administration. Also, does anybody know what else is considered a "surgery?"

I'm sorry you were unable to locate this.  Here it is:

http://gpsc.duke.edu/business/internal_committees/health_insurance

For the coming year you should apply for a waiver at the start of the open-enrollment (mid-July) and no later than September 15, 2009.

For the record, the committee has no stake in the enrolment in the Duke plan; the more people who do enrol the cheaper, typically, the rates can become, but this would not influence us as committee members.  The interest of the committee is to represent the Graduate and Professional students, and to some extent, help the Undergraduates.

As far as the decision to change, the reason that it is made so early is because that is how long it takes to change.  All of the problems that were experienced with Blue Cross and Blue Shield had to wait until we could prepare adequately for a change.

You can add a spouse and child(ren) to the plan following any qualifying event (as per state law).  If you do this at the beginning of the year it can be done online, otherwise call customer service to have the rates pro-rated.

Maybe I am the only person who has had to go so far as to file a grievance, but I am told they have 45 days to process such and issue a final determination. Funny, they have record of receiving it, but then never did anything about it. Today is day 49 and there has been absolutely no action on this grievance. Meanwhile, I have been putting off the hospital bills since September. This is ridiculous.

Also, they appear to have no official grievance policy in place, at least as far as their insurance booklet has outlined or can be found on the SHC or UHCSR website. (Is it just me or is it also ridiculous that I have to check THREE separate places for this information?) I am now going to file a complaint with the Department of Insurance for failure to acknowledge a grievance and failure to process within the 45 days allowed to them.

Right now payments are made directly to United and I'm not sure how Duke reimburses you for the different network.

It's important to note that the graduate school will only pay for your health insurance if you use the United plan. If you choose something else, you get to pay out of pocket for it and are not reimbursed for anything.

http://gradschool.duke.edu/documents/financial_support/Grad%20Sch%20Payment%20of%20Health%20Insurance%2009.pdf

I, for one, remain absolutely appalled by my experience with United.

If nothing else, perhaps we could at least get some of the grads from the law school jobs on this case since we are helping to fund it anyways...

From the AmLaw Litigation Daily
http://www.law.com/jsp/tal/digestTAL.jsp?id=1202430463692

UnitedHealth Discloses (Another) $17 Million in Legal Bills for Options Backdating Defense
By Andrew Longstreth
May 05, 2009
You didn't think UnitedHealth Group's humungous $895 million securities class action settlement of options backdating allegations last year meant the end of the company's options backdating legal expenses, did you? Of course not! United's legal bills continue to mount, as Michelle Leder notes at Footnoted.org. Leder reports that in United's recent proxy statement, the company says it spent about $16.8 million on legal fees for the defense of current and former officers and directors who have been named in various options backdating suits. Leder calculates that United has spent nearly $50 million defending the individuals since 2006.

Frankly, we thought it would be more, especially considering that the since-settled class action named 18 individual defendants. After all, Brocade (grudgingly) paid more than $46 million to Skadden, Arps, Slate, Meagher & Flom to defend one individual--former CEO Gregory Reyes--for his role in the backdating scandal at that company.

We assume that a significant chunk of United's $50 million payout has gone to Latham & Watkins, where partner David Brodksy has been representing former United CEO William McGuire. In 2007, Brodsky represented McGuire in a settlement with the Securities and Exchange Commission. And last year, with the help of Brodsky, McGuire agreed to pay $30 million to settle the class action claims against him. Brodsky did not immediately return our call for comment

So,  according to one of the health insurance meetings, David Kahler said that the decision to remain with United for 2009-2010 was made in July 2008.  I don't know why the decision was made way back then, way before Duke even had a chance to try out United and grow to hate it, but that's what the committee decided.  The committee for the Duke Health Insurance is made up of these people:

David Kahler

Claire Gordy

Matthew Vandenberg

Alana Belcon

Whitney Shaffer

Kristin Maloney

Brian Lutz

Karen Lai

Heather Endriss

Amanda Kasper

Erin Bressler

Michelle Tougas

 I'm assuming that the 2010-2011 health insurance decision will again be determined in July, so if you want the committee to have your input, I would suggest emailing them directly.  You can find their contact information here: http://gpsc.duke.edu/uc/shiac     Or, through a search of the Duke database.  

If you really hate United and do not want them for 2009-2010, there is another option: Just don't sign up for United.  Duke allows that graduate students can find a comparable network, so if you want to go back to BCBS you can, or you can find another plan.  It means a bit more work in finding the plan you want, and will probably be another $100-300 more, but it does mean that you don't have to deal with United.  I believe there is a waiver that you need to fill out before September 15.  Right now payments are made directly to United and I'm not sure how Duke reimburses you for the different network.  I asked David Kahler to put up information on the website so students would know about this option, but he hasn't yet.  I'm assuming the committee would rather people not know about this option.

As a soon-to-be dad I would also like to follow-up on comments posted about the appaling maternity coverage offered by United. My wife is under coverage as a spouse and lets just say that I am less than thrilled at the idea of placing my child under the care of a United plan. I thought insurance was supposed to cover medical expenses in the case of the unexpected. My wife and I never planned to get pregnant, but it happened and we are thrilled to be parents. United is obviously not thrilled about paying for appointments and exams. As I understood, a full fetal ultrasound was standard procedure at 18-20 weeks postconception. Why this $700+ charge was not covered is beyond my understanding despite continual calls to United Healthcare for information. I am sick of paying $888 every 4 months for pitiful coverage. This is our last round with United. Once our baby is born, adios. 

It seems to me that UHCSR has struck the nerves of many graduate students throughout the year so has a decision been made about our health care options for the upcoming school year?

Coverage is horrible! 

As a soon to be father, I have had a chance to review Uniteds coverage for maternity and found it to be the one of the worst for maternity coverage. Granted, not all students plan to add spouses or to have children, but wouldnt it be nice if it were at least possible!

J

Never in my life has health insurance taken this much of my time and made me this frustrated. It reaches new heights of ridiculousness every time I incur a medical expense.

Now they're telling me that in order to get any payment for an out-of-network claim, meeting the $300 individual deductible is not sufficient. No, since I have a dependent, I need to meet the $900 family deductible before they make any payment on my claim.

Great news. And conveniently, a manager was NOT available. As per usual.

I was incorrectly told by two different United reps that my birthing center was out of network under our plan. Since I had already been seeing the midwives there for a few months under Blue Cross, this would have been a huge problem for me. It would have meant paying a lot more for my son’s birth at the birth center than originally planned, or going to a hospital birth and OBGYN which was not what we had wanted. Someone in the business office at the birth center was able to work her way up the United ladder and figure things out eventually, but United’s customer service was hardly helpful.

Partway through my pregnancy, the birthing center sent a request to United asking for my anticipated financial contribution for the birth. I had already paid over $500 in a deposit and had budgeted some money on my husband’s healthcare spending account to cover the remainder. United responded that I would not have anything more to pay (unless something unusual came up and there was a hospital transfer, etc). My birthing center recorded the rep’s name. After the routine birth and several months into the new year (when it was too late to use the HCSA), I got a bill for about $900. Apparently I was responsible for a remainder of the expenses, but someone at United had been too lazy to do the math. They also calculated my bill incorrectly (charged me out of network) and I had to call back and remind them that we had already had this in/out network discussion months before. The bill fell to $400 and I am slowly paying that off, but it sure would have been nice to use the health care spending account. I left a message with a manager at United about this, but she has never bothered to return my call.

I also had been getting 3 month supplies of a prescription that I have been taking for over a year under BCBS. The first time I went to get my prescription refilled under the United plan, I learned that the policy did not allow for 3 month refills. I called United and complained to a manager who told me that he would make a note on my account that would allow me to refill my prescriptions for 3 months. The next month I went to refill my prescription and was told that I could not get a 3 month supply, only a one month supply. I called United again. There was no note on my account and the customer service rep would not do anything to help me.

I would love to see a change back to BCBS. 

All mental health providers that were identified by CAPS or by students (in response to surveys) that students utilize were given an opportunity to join a special Duke-only network.  If you encounter a provider that students use who is not in-network, contact the GPSC committee (dukestudentinsurance@gmail.com) because either:

1. We were unaware that students utilized this provider
2. The provider refused to join with StudentResources (even though it would be separate from United, who have the bad reimbursement reputation)
3. The provider failed United internal credentialing process - not likely.

Lastly, the online directory does not have all of the Duke network providers listed (because they are not part of the network for others).  Please see CAPS or ask the committee about these other providers.

Your best bet is to contact Jean Hanson at Student Health (jean.hanson@duke.edu) or the GPSC Health Insurance Committee (dukestudentinsurance@gmail.com) with your situation.  Most problems that people have encountered can be easily resolved if you contact us.

The state DOI will investigate any claim that appears to be in conflict with state law, but most of the complaints that have appeared here are simply miscommunications or errors on the part of Duke.

That is not to say that some of you have legitimate complaints - you are well within your right to file any complaint, but we do encourage you to let us know as well because:

1. If there is a legal violation, we would like to know about it
2. If there is no legal violation, the contacts at Duke are the best shot at getting your problem solved.

I want to let people know about another resource to make your voice heard and get your complaints addressed. The North Carolina Department of Insurance oversees the insurance industry and responds to consumer complaints. You can file a complaint on their website. It's quick and easy.

North Carolina Department of Insurance site to file a complaint:
http://www.ncdoi.com/Consumer/consumer_complaint_info.asp

I'm not that familiar with the NC Department, but in some states insurance departments have taken decisive action in response to complaints. If enough people make the issues with UHCSR known, the Insurance Department may help resolve some of the problems we've had with UHCSR.

So, I just learned that only ONE mental health provider that is covered by our plan is actually at Duke. That is shameful. I know my provider had to stop seeing several patients cause she is not considered in network. Also, my provider told me that administration at in the psychiatry and cognitive therapy department do not want to accept UHC insurance because there has been numerous attempts to collect money owed due to patient claims that have been denied. I know my provider has barely been paid at all over the last few months. 

What was Duke thinking giving us students such a useless plan? 

Well, I just spent more of my time dealing with UHCSR's bs. In addition to giving me the benefit level of an ER visit when the claim was clearly for a clinic visit (for which I have to spend still MORE of my time to file a written grievance, which may or may not even resolve the issue, and I still may have to cough up an extra hundred something dollars), UHCSR supposedly never received two later claims from the same hospital. Now I know the hospital's insurance specialist quite well, we have spent a lot of time on the phone together. And she knows the difference between UHCSR and UHC. She has talked to UHCSR reps directly. And they have indeed been sending everything to UHCSR. (As evidenced by the previous benefit-level switcharoo UHCSR pulled on me detailed above.) Yet UHCSR claims they never received these two claims. And when the hospital resubmitted, UHCSR denied the claims because they were duplicates.

Duplicates of claims they SUPPOSEDLY NEVER RECEIVED, and definitely never paid. What?!?!??!!

What kind of tactic is this? I'm more suspicious than ever that they are just trying to save a buck by screwing us over. At any rate, I'm absolutely furious over this.

We have reached the point where we're afraid to go to the doctor because we don't know if the insurance will pay anything, or if they're going to use stall tactics or other bs to avoid paying. If that's the case, how is this better than no insurance at all?

I had zero complaints about our insurance with BCBS, and we unfortunately had to use it quite heavily during the last school year. Never did I have a problem with a claim getting paid incorrectly or denied. Count me as EXTREMELY DISSATISFIED.

Okay, we have United since middle of August 2008. Last night I JUST got a let from Private Diagnostic Clinic that none of my visits with my psychologist have been covered. Turns out that almost seven months later I am finally being notified that my therapist is not part of United's Mental Health network. What BS!! So United wants me to pay over $130 per session. What, they want someone suffering from depression to be left untreated? I can't afford that every week. I WANT my old insurance back. This plan SUCKS and the more I find out about the more I hate it. I still can't permission to see my dietician, and now I was literally told on the phone last night that "I am being overcharged and need to find a new provider." I want to know how and why this company gets away with treating its clients so poorly. If I didn't have an ultra expensive health condition that would make getting insurance on my own impossible, I would dump United right this second. I want someone to explain to me why my government is spending billions oversees but can't find a way for diabetics to recieve life saving treatment at affordable prices. That is a huge problem, and makes me ashamed to be American. 

We need to dump United as soon as possible. They have NOT lived up to their promise the provide comparable service to BCBS. The rules are irrational, and not explained. I paid over $1500 for this plan and now will have to pay easily over another $1,000 out of pocket on top of my monthly couple hundred for meds. Never mind my insulin pump is costing me $2000 and I will be paying for it for two years. There is NO provision in any student loan to even come close to covering these outrageous expenses and I can't believe that while being a student at a university with such a reputable hospital, no one can figure out how to get me an insurance plan that makes sense!!!! I am at Duke, how can Duke providers be out of network??

After the GPSC meeting with the United Healthcare Reps, I am still very unsatisfied with United on two main issues. 

 1. Rejected Claims

I had several claims rejected by United Healthcare claiming that my coverage had been terminated. I spent several hours on the phone trying to prove that I did indeed have coverage and that United needed to process my claims. The customer service office was extremely unhelpful, and I had to do most of the legwork to resolve the situation. At the GPSC meeting, the United reps told us that they knew there was a big problem with processing claims and that many of them were ending up at the wrong office. (Although the hospital had filed my claims online.) If United knew this was a widespread problem, they should have notified us. All they needed to do was send a brief email to all subscribers telling them about the trouble with claims and what could be done to fix it. If they had a real committment to customer service, they could have easily saved many students from long, frustrating hours trying to figure out why their claims were being rejected. 

2. Multiple doctors in one day 

United refuses to cover multiple doctor visits in one day. If you do go to more than one doctor (or even just get billed for different services from the same doctor), you're stuck with an extra bill. While students have some flexibility in their schedule, it's often more convenient to get two doctor's visits taken care of in one day. Not to mention that if I saw my doctor in the morning, and had a medical emergency in the afternoon, United would refuse to cover the doctor's bill. When I tried to ask about the justification for this policy, the rep said he would have to check and see if this policy was also in place with Blue Cross Blue Shield. That's irrelevant. We're contracted with United Healthcare Student Resources, not Blue Cross Blue Shield. If United doesn't have a good justification for this policy, it needs to be eliminated. It sounds like price gouging, and the rep's answer didn't convince me otherwise. 

Early on in our plan we sent our representatives feedback on the trouble students were having with their customer service.  StudentResources responded by providing better information and training to their customer service representatives.  We (GPSC Health Insurance Committee) continue to hear bad reports about UHCSR Customer Service but no one that has talked to us about their experience.  We even sent out this survey:

http://gpsc.duke.edu/survey/StudentResources_Customer

(if you didn't get it, ask your GPSC rep) to gather information on current customer service performance.  If you provider the phone number that you called from we can insist that the call is reviewed (they record every call made) and we can work together to fix this problem.  Unfortunately, as of this past weekend, no one has filled out the survey.  This gives us no data for them to look at.  Please, if you have a problem, fill out this survey.

A note about the typical doctor's response to United Healthcare: UHC has a reputation for delays in claims payment - they have a legal obligation to do it within a certain time frame which they do, but most others do it faster.  The confusing part for doctors is that we don't have United Healthcare, we have United Healthcare StudentResources (StudentResources was aquired by UHC, but retained their own claims administration).  The repayment from StudentResources has been very fast.

In the event that services are not available from an in-network provider in an area (in this case the "area" is defined as 50 miles radius from DUML), benefits will be paid at the in-network level to the provider of your choice (up to the usual and customary charge for the area defined as the first three digits of the zip code as the 90th percentile of the charges for a given procedure code or service).  Please consult with customer service for your specific case as we have found that the online provider directory is not always up-to-date (another aspect that we are working on, although this is maintained by United Healthcare, not StudentResources).

I'm a PhD student at the marine lab and this new healthcare programs does not have enough enrolled providers in the area.  Furthermore, we're expected to drive up to 50 miles to visit the few doctors they have enrolled in the plan.  We do have access to Beach Care, but this is for illness and physicals; there are no specialists at the facility to assist us with long-term issues like allergies or physical therapy.  I know they are working to enroll more providers but this should have been considered before we switched.

I am glad, however, that someone was able to figure out how to access our prescription coverage with medco (365.wellst.com), because my emails and calls to technical and customer service were unhelpful.  They couldn't find my name or plan despite my telling them I was with UHC student resources.  I contacted Ms.Hanson, our Duke rep to UHCSR, and she put me in touch with their rep, Ms.Fingerman.  After several emails, even she couldn't get me a login.  I worked on this for over a month and then gave up.  I guess the message is that you have to continually call them until someone who knows what they're doing answers.

United Must Go!  We're paying dollars for a plan that is close to useless.

The customer serive makes you jump through hurdles.  When you tell doctors you have United... all you hear is a sigh.  It's sad.

Representatives from United Healthcare StudentResources will visit your campus next week.  We are looking for feedback on what we are doing right and what can be improved.  There are two meetings.

GPSC GA Meeting: Tuesday, March 3, 6:00pm, Divinity School (Westbrook Wing) room 0016W

6:30pm: Our Student Medical Insurance Plan

• Introduction
• Policy highlights of United Healthcare StudentResources

1. 1. Ability to contract with the mental health providers that Duke students use
   2. Ability to offer the copay benefits that we requested
   3. Offer of the premium arrangement that protects us against overpayment of premium

• Customer Service
  • Response to customer service issues
• How to respond if your claim is rejected
  • Why are claims rejected?
  • Resources: Customer Service, Student Health
  • Rights under policy and law

6:50pm: Prescription Drugs: How prescription plans work and why things cost what they cos

• What makes a tier # drug that tier?
• How prescription plans work, specifically, how ours works

7:10: Questions

Questions will be limited to general policy questions.  Specific questions are appropriate for the open forum (below).

Open Forum: Wednesday, March 4, 9:00 - 11:00am, BioSci room 154

Topics that we are looking for feedback on are:

• Customer Service
• Filing claims
• Improvements for this year and subsequent years

I just went through a huge run around to get to the prescription information (which is housed on Medco's webpage with a link off of United's webpage www.uhcsr.com).  Basically, United links us to Medco to get prescription information, but to create an account on Medco's page you need a 9 or 11 digit member number, while United has 7 digit numbers. 

To save yourself the hourlong headache I just endured talking to useless people at both United and Medco, call their webpage support 1-800-711-5672  The guy there was incredibly nice and helpful and, after confirming that I was who I said I was, he bypassed the Medco registration page and set up an account for me that worked.  

(The reason I had to go through all of this was that United won't let me get one of my prescriptions from a local pharmacy, which I would prefer, but requires that I get it from Medco.  The problem with this is the medication requires refrigeration, meaning I have to be home to accept the UPS shipment on a weekday.  They also refused to honor a manufacturer discount card for the medication, even though the manufacturer says that Medco does accept the discount (luckily they are trying to fix it for me))

I'm glad we are getting rid of them, but we are still stuck.   I had some visits in OCTOBER that were covered and all of my invoices in the mail said that things were covered.  Then in JANUARY I was told that I needed to fill out a survey verifying that I didn't not get hurt while playing on a varsity team before they paid the claims - - they said it was in the mail.  It wasn't.  I called and requested the survey four separate times and each time the customer service representative said that the survey would go in the mail the next day.  I kept calling when it never arrived.  I just received the entire billl and a letter saying that they refuse to cover my appointments because "the requested information was never receieved from me".  However, I couldn't provide the information because they never sent me the forms to fill out!  I'm beyond annoyed and I'm terrified that I will be stuck with this bill when I've done everything in my power (other than driving to their office) to get these forms.  Their bills seems to have no trouble getting to me, but things that would actually be beneficial never, ever, seem to make it.  If anyone has had this problem, please let me know what I should do to get this solved efficiently.

 I'm not sure where this information should be getting disseminated from, but the plan was updated again (it'd be great if Student Health would update their link too)

https://www.uhcsr.com/Public/ClientBrochures/2008_928_1_Brochure_v10_NOC2.pdf

joshua.wilson@duke.edu

I have had 3 insurance companies (all through university packages) in the last 4 years, and none of them have required as much jumping through hoops as United Student Health Care.

I have been to a grand total of one routine doctors visit and have been charged (incorrectly) for it now three times by USHC. This is unacceptable, and I really hope that Duke is seriously considering dumping them.  

Three-month supplies have been available for birth control since September.  The one-month supply was not an intended or disclosed consequence of the copay system and it was changed quickly.  The three-month supply has only cost one copay in the past, but it will soon be changing to two copays.

When you say you would vote to return to Blue Cross Blue Shield, is it because of the copay structure of the prescription plan, or something else?  Because there was a strong desire to move to a copay plan this year regardless of the carrier.  If there were a compelling reason and a proven majority of members who prefer the coinsurance with deductible program we can change back even with StudentResources.

I have pretty limited regular healthcare needs, so I can't speak for the entire package offered by United.  However, the few things that I do rely on have been made much more complicated/expensive because of this plan.  Basically, my preferred method of contraception quadrupled in price and I can only get one month at a time (apparently I can also order 3 months online but for twice the retail price!!!)  This is my most frequent healthcare cost, and it is almost prohibitively expensive.  I have never heard of charging students so much for basic pharmaceuticals or limiting women to one month at a time (I still haven't heard any sensible explanation for this rule).  The whole tier thing is frustrating, because while cheaper contraceptives may be available, some of us have important (and health-related) reasons for selecting a particular medication.  Thus, effectively those in Tier 1 are not viable options.  Anyway, I would definitely vote for going back to BCBS.  Thanks for bringing this up!

GPSC,

It is more than apparent that Duke Graduate Students are NOT happy with United.  Is there a movement at GPSC to switch back to BSBC or another plan?  Does anyone in charge of this know?  I don't believe it would be in the Graduate Students' best interest to remain with United.

kc

I am preparing to file a grievance against UHCSR over a simple clinic visit.

The hospital used a clinic visit/ER code along with a clinic visit code, and sent it off to UHCSR. They processed it as ER- less out of their pockets. The hospital resubmitted. Same response from UHCSR. The hospital resubmitted, and the lady in charge of billing called them explicitly to point out that the second clinic visit code meant that it was to be billed as a clinic visit, they should know this because that's how it's done. Same response. We have been through that former step 3 times now, and the billing rep says there is no more she can do for me if it is not processed properly this time. All the proper CPT codes have been used, and this is not a common problem. The only remaining thing for me to do is to file a grievance. Fortunately, the hospital has been more than willing to work with me on this.

I am not paying the higher deductible for an ER visit, when a clinic visit is supposed to be paid at 80%.

Koster sucked, but these guys make dealing with Koster look easy.

Also, regarding HIPAA, if my spouse's information is protected from me, then HOW COME THE EXPLANATION OF BENEFITS STATEMENTS COME IN MY NAME??!?!?!

Eye Care Associates - Visionary, 4102 N. Roxboro Rd. takes UHCSR insurance.

For an appointment call 595-2020

Not sure if anyone has posted this, but some bcbs plans will allow you to receive your prescription for free if you opt for the generic instead of the name brand drug.  That's a serious perk to investigating a switch back to BCBS.

I vote to go back BCBS. I hate united health care! My copays are more expensive than the 20% copay we had with BCBS, united health didn't cover two of my visits to the doctor because it was considered "preventative" care. One of my doctors was out-of-network after the health care changed and even though she is participating in a special program with Duke that allows her to keep her patients from before last year, UHC is charging me the $300 out-of-network deductible. They are still working to resolve this problem and it has been several months. And in trying to make my life easier, I scheduled two of my appointments for the same day, and they wouldn't pay the second doctor because apparently I am not permitted more than one visit per day for that field of care even though the visit was for unrelated health issues and with a different kind of doctor. I was out $120. BCBS was amazing health insurance, they covered everything and the customer service was great. For people who have a lot of medical problems, united health care just does not cut it.

 I filed a claim with UnitetHealthCare in October 2008 for Vision Hardware. This is supposed to be a straight-forward $100 reimbursement, but its been about 5 months and I'm still struggling to clear up the big mess that they have made with it. 

This is an excellent example of the problem that so many providers have been causing.  WE DO NOT HAVE UNITED HEALTHCARE, we have United HealthCare StudentResources and they have different claims administrators.  Now, I'm not promising that (for everyone reading) your claims are denied purely because of this, but if your claim comes back as no coverage, chances are the provider sent it to the wrong address.  If you were seen at Duke, it's almost guarenteed that it was sent to the wrong address.  Here's what happens:

You give your membership card to the provider and he/she sees United written on the card and process the payment to United HealthCare, where you are not covered.

or

You give your membership card to the provider and he/she seed United Healthcare StudentResources and finds the closest thing listed in their computer system, United Healthcare and sends it there.  The reason that StudentResources may not be listed is that they were aquired by United and used to have a different company heading.  This is actually what was happening at Duke.

So, further down this forum topic there are instructions on how to correct your provider.  They are also on the Health Insurance section linked at the top of this page.  The reason that I know this is (at least one of the things) what happened is that United HealthCare doesn't have your StudentResources information and StudentResources doesn't have your former United information.

In conclusion, we have been experiencing problems with United, but this is not one of them.  This is because providers don't pay attention or update their information enough.  We are looking at ways to improve the network there, unfortunately it is a slow process.

Thanks,

David

When you are a student at the Marine Lab you can be seen at Beach Care as part of your health fee.  Annual exams are available.

We understand that this may not be your first choice, but I wanted to make sure you knew it was available to you.  We are aware of this problem and are working to find a resolution.  If you have any other questions you can contact the GSPC Health Insurance committee at dukestudentinsurance@gmail.com.

We do not have a benefit for oral surgery, nor did we have one previously.  This is not specific to United at all.

-David

I'm sorry that you had a problem with customer service, there should have been a supervisor available to you.  However, the supervisor would have explained that the Health Information Portability and Accountability Act (HIPAA) of 1996, specifically the HIPAA Privacy Rule prohibits any information classified as personal health information (PHI) from being shared with anyone that does not have the patients explicit written permission.  PHI is generated for the sole purpose of retaining and transferring patient information for and within health professionals that need it to treat you - there are categorical exclusions to PHI privacy in emergencies for emergency room doctors and related personnel, but aside from that no one sees your information without your permission.  When you said this wasn't a problem before, that means whomever you spoke with violated federal law.

My wife has to have surgery to remove wisdom teeth. Guess what, they cover nothing.

They have a specific note that they only cover oral surgery if the patient is under 9 years old. b/s

Good thing I pay premiums and then have to shell out my own money for treatment.

My vote is to dump them.

What is our course of action for getting rid of this unacceptable coverage? I am happy to help and organize. Also, I am interested in familial/spousal benefits at reduced rates for grad students, and am willing to fight for the cause.

I agree that United HC has silly and stupid rules about what they cover and don't. I was diagnosed type 1 diabetes in Oct. of 2007. With BCBS at the time I had no issues. Then they switched us to United. After what was the hardest year of my life the people at United told me my doctors were not preferred providersand ALL of my monthly co-pays skyrocketed. I was most upset when I was informed they provide no coverage for nutrition visits unless its with a m.d.! Hello, m.d.'s do not do nutrition counseling. That is why Duke employees specific dieticians in the Adult Diabetes Education program. So now I can't make any appts. with my nutritionist unless I want to pay out of pocket. They are complete idiots at United!

As several others have noted, United Healthcare is entirely useless for Marine Lab students.  I'm also at the marine lab and just needed a routine female physical.  There are simply no in-network providers here who can provide that kind of service. In fact, there are only two in-network "family physicians" in this area, and both have received mediocre-to-bad reviews (and incidentally, both are male).  I ended up having to take two days out of my week to drive up to Durham and back for something that should have taken twenty minutes.  This is an utterly ridiculous situation.  Please bring back BCBS!

Hello. United Health does not cover doctor's appointments that are related to surgical procudures.  Unforunately, doctors offices code many things as surgical procedures that normal people would not consider to be surgeries.  Thus, United Health would not pay for my doctor's appointemtn because I had a cortisone injection.  I realize that all health insurances have their problems; however, I find this practice to be deceptive. I read the medical benefits several times and had no idea that this was not covered.  I was wondering if other people are having similar experiences.  If so, perhaps we can get a list of procedures that are not fully covered and put them on the website so that students can at least make informed choices.