I have United Healthcare, and I hate them. My daughter receives speech therapy caused by developmental delay. Last year, they covered it, BUT my provider was out of network (common with United). So, I had to submit the claim myself, and I would include the reports showing medical necessity. They routinely sat on the claim about 30 days, then denied it, then evaluated it once I appealed the denial. Then, they would claim that the provider had not sent them the reports they requested, and I would confirm that the reports had been sent by the provider. THEN, they would claim they must be lost, so the provider would need to fax them. Then they would sit on the claim again. It took until nearly Christmas to have the bills from September paid for treatment that was necessary and which had said up front in the evaluations would be required for at least 6-9 months (ie. - they shouldn't have required new documentation two months into it). This year, they are in network with the speech provider, but now they have an arbitrary 30 session limit that was long ago expired.
My daughter now also has physical and occupational therapy due to developmental delays related to motor skills and sensory processing. My insurance covers an unlimited number of visits for physical and occupational therapy caused by developmental delay. The provider is out of network, so they will cover 60%. The initial evaluation was $650, and the therapy is twice a week for a total of almost $300 per week. Paying up front, it's a bit like my savings account sprung a giant leak. The coverage for this seems pretty straightforward. In fact, I notified them prior to the evaluation and therapy and asked about coverage, so they even confirmed it for me up front. From July through now, they have yet to pay a dime...I have nearly $4,000 in outstanding claims that increases by $280 a week. First, they denied the claim for the evaluation stating "no coverage" and a reason so vague that neither the provider nor I could even understand the basis. I contacted them for explanation and was told they needed reports, clinical notes, etc before they could cover. I suggested that they should have done that as part of their claim evaluation vs. denying it without even investigating the validity. They said they would reevaluate. I waited a month, contacted them for status, and they informed me that I had not sent them the reports, clinical notes, etc. so they weren't doing anything. I told them they didn't ASK me to send it, they said they were getting the info and that I really thought that was their responsibility in evaluating the claim. I informed them that I would happily fax what I have but do not believe they are processing my claims with good faith. That got their attention a bit. Within about four hours of telling them that, the therapy provider notified me that my health insurance carrier had just called them to ask them to fax this information. They told my insurance carrier that they had sent the information to them twice already, and United said that they didn't receive the documents and they must be lost. So, they needed it faxed to them. That was a week ago....I thoroughly expect them to deny all of the claims again at least one more time. The claim is clearly covered, but United's standard protocol seems to be to hold the claim nearly 30 days, deny it, evaluate it if the denial is questioned, supposedly not receive the documents needed to assess the claim and then hold the claim another 30 days after definitively receiving any needed reports. For my situation, I anticipate that I am going to need to hire an attorney to get the claims paid, despite how clearcut it is is. My daughter's treatment will last 6 months and will continue at least another 6 months if results are being seen. I'm looking at nearly $15,000 in treatment, of which United should cover $8,000 with me covering $7,000 (40% and $1000 deductible). Between my employer and myself, United receives over $10,000 premium for my policy, and they definitely get their money every payday.
Yep, I seriously dislike United Healthcare. I've only had Aetna for dental coverage, and they handled that with not problem at all.