Health Insurance - Edmond,OK

Updated on February 26, 2010
N.V. asks from Edmond, OK
5 answers

We are self employed so about once every 12 months we have to shop for new insurance due to rate increases. We are currently with Great West PPO. It has been a fairly decent plan so far, but we are a healthy family, so no major needs. The new plan i am looking at is with Golden Rule - which is a United Health Care company. There are certain things about this plan that I find attractive that are not on my current plan - one major one being that we don't have to meet the deductible (current plan: $5,000, new plan will be $5,000 as well) unless we are admitted to the hospital. Anything else outpatient like x-rays, lab work, etc., we will just have to pay our 20% co-insurance. So, to get to my concern. I was talking to my Chiropractor the other day and he was telling me that United Health Care is one of the worst plans and that they are terrible about paying claims. He said "it all looks good on paper, but in reality it is not!" Of course this raised a red flag in my mind, but at the same time, this is coming from a Chiropractor. There are not a lot of insurance companies that willingly pay mega bucks for chiropractic care. So, i am looking for absolutely any input / experiences with either of these companies - Great West and United Health Care (Golden Rule). I need to figure this out asap b/c my application is in process and they will be drafting my account any day now. Thanks so much for your time!

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B.B.

answers from Missoula on

I can't offer any information on Great West, but I work for a doctor and handle all of the office's insurance billing. It has been my experience that United Health Care is one of the most difficult insurance companies to deal with. They do everything possible to avoid paying claims, including losing the paperwork and claiming that current, accurate codes are incorrect. This is just my experience. If they are the company that makes the most sense for you financially, then I would suggest just being extra sure about what you are getting, which docs are covered and to what extent. You may have to keep a closer eye on them to get claims paid.
Best of luck to you and your family!

1 mom found this helpful
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S.B.

answers from Dallas on

we used to have United Healthcare and I never had a problem with them paying claims. Check to make sure your physicians are on their plan before you sign up and make sure your you are happy with their choice of specialists on the plan. I do not have experience with their Golden Rule plan specifically.

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L.T.

answers from Pittsburgh on

We have Golden Rule insurance and have not had any problems with it on our end as subscribers. In fact, 3 months after purchasing it my son was diagnosed with leukemia. As you can imagine we have a ton of claims - clinic visits, chemo, ER visits, hospital stays, daily meds, surgeries, etc. They investigated to be sure this wasn't a pre-existing condition before paying out any claims and at least once a year they notify us that a claim has been submitted that they need to research before they will pay the claim. They must complete their research in a reasonable amount of time since the medical facilities have never tried to collect the money from us. Anytime I have called Golden Rule to help figure out a billing error or to check on info I have received helpful service. The only complaint I have in 4 years with them is with one rep who asked me if I compared the explanation of benefits against the bill the hospital sent (billing error from hospital). There was no way to compare the 2 documents as they each recorded the info differently. It was like comparing apples to oranges. Good luck with your decision.

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B.S.

answers from Tampa on

I have Golden Rule and I'm not 100% satisfied. I pay about $200 a month and I just got a bill from my Dr for $150 because I went in to get a refill for my inhaler and my pre existing asthma is not covered. Also, every time I get blood work done I recieve one bill after another- even if I pay the day of service. Unfortunately, you really have to pay for good insurance. If i could afford $350 a month I would have a much better plan, but that's a lot of money. Insurance is a scam.

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S.B.

answers from Dallas on

I live in Texas and used a plan that sounds exactly like this for a few years. I would still be on it, but they no longer serve our area. When you factored in the low monthly payments, the plan worked out well for us. My children's immunizations were covered, so well visits were not outrageous. We were also careful whenever we went to the doctor, making sure costs were covered before we had procedures done and making sure things were coded correctly. Most of the time things went smoothly. There were a few minor incidents that some time was spent on the phone. And I too was told they are a company difficult to work with. We did have to fight for the company to cover a few of our costs - I got a sudden and severe bladder infection and wound up in an urgent care facility. The claim was originally denied. I worked with the facility and won the appeal. If you are diligent and prepared to do a little leg work the plan may work well for you.

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