United has denied numerous claims based on a 3rd party reviewing the claims. However, they refuse to give the reason for denial which prevents the doctor's office from correcting the problem or from appealing. That is against the Provider Agreement the insurance company signed. The 3rd party, meanwhile, are paid a percentage of claims they find a reason to deny. The doctor cannot successfully appeal and continues to file the claims "incorrectly" resulting in even more denials. Someone needs to file a class action lawsuit against United.

I was a long term employee of At&t untill I suffered an injury
that put me on disability and eventually having 20 plus yrs with
AT&T they retired me. My disability is tough enough to live a quality
of life with the aftereffects of RSD
I the gall of 2010, I was coming up my deck steps
holding the railing, my knee gave out and my arm, causing me
to fall face first on the deck with nothing to break my fall.
I tried to get up but couldn't, my fiancé heard my scream
and helped me get up, not realizing the blood from my nose
and mouth. After finally getting the blood to stop, I had swollowed
a tooth and a piece of another. The pain in my mouth felt like
someone hit me with a brick. I called my insurance for help
because the pain was getting worse and my gums were swelling up.
At first, in calling my At&t benifits it appeared that there was help
under my medical for dental accidents, they got my to
uhc to help me through the process. Since there was no oral surgeon that was covered under both they approved me to see a oral surgeon assuring me that my coverage from the accident would be covered under my medical. It is a matter of co/pay being hard to cover bs impossible.
In seeing the oral surgeon there was so much swelling of my gums and
nose it was hard to determine a course of action. So he medicated and scheduled follow- up. Well as the healing progressed or rather
the result of the fall showing the impact the fall had on my mouth
was aweful. My upper teeth began receeding from the gums, bleeding
and bruising worsened, my lower teeth loosened, broke, chipped away.
What was once manageable with fillings and losing a couple
back teeth due to my heath, became a fact that all the time and
money I had to pay out of pocket over the yrs was wasted. My dentist
dr aiello's put an extensive plan together as required by my insurance
before treating. So months go by with pain and frustration and alot
of hours by my dentists mgr Patti providing medical -dental codes not
knowing as the recovery or disaster in my mouth
was going to continue. Well I faced the facts my teeth
had to go, there were no
guarantees, I heal slow due to my disability.
So, dr aiello's sent a comprehensive pkge in as best
they could looking at whY may occur in process, it was
finally approved, the next step was due to concern
of my health that an oral surgeon was required
by the knowledge of my dentist to do the extractions, so I
could be monitored in case something went wrong.
So know dr santerelli's office had to submit for
their approval for all remaining extractions, now as
many of the teeth were starting to decay, exposed nerves,
teeth becoming worse due to time passing. They got denial, then
approval, then at Christmas when the submitted for
pte approval for sedation, someone looked at it, rejected it
because sedation was already covered under medical. I called in again
so upset and was told we don't talk to patients we talk
to providers... Are you kidding me, my speech, ability to eat and pain were becoming worse and worse. I got a call from UHC representative
that helped dentist who was on special assignment
when oral surgeon approval got cancelled in error.
To sum this up, there iscno one person manage
my case and they were doing me a favor by talking to me.
They won't pay for sedation of 10 plus teeth being
removed with my gums still not healed. My dentist has ordered
a partial for on bottom, otherwise I wld have to
risk surgery to remove 2 bones in my my mouth
that are in the way. They will cover some removals but
not the ones that decayed or fallen apart since which makea
all of this insane, painful, unaffordable, unhealthy
for my condition and let's also not sedate her so
she can suffer more. I begged for one person to handle since
each piece of this was approved in parts, denied in
pards and then changed by someone else.

Had I not fallen, I would not require a partial on the
bottom of my mouth nor a denture on the top.

Even with coverage I am Struggling to find the
co- pay.., . And this pain added to my disability
is inhumainr and barbric.

Last words from UHC, your right this does not
make sense and I can't explain nor get you to
anyone that can... Sorry I guess you have to
appeal again... Goodbye

also covered under mefical

AARP, a division of United Health Care(UHC), advised that I could reduce my monthly health care payments to zero dollars, and still keep my current doctors.This proved to be untrue.It was a fraudulent attempt to have me change from my existing UHC plan at $200/month to a no fee AARP Complete Solutions plan, also endorsed by UHC.I registered, rec'd my membership card with my doctors name on it.However, my doctor was not part of this plan.My wife was distraught that we could not use our current doctors.We had to opt out of the AARP plan and purchase a more costly plan at $517/month.All my conversations were recorded, however UHC said that the tapes recording my conversations with the unscrupulos sales agent could not be retrieved?Can someone recomean a qualified attorney to help me ?

My wife had to go to a specialist because her hearing is getting very bad.Well I go on uhc website to see if the specialist that her primary doctor refer her to is in the network, and he was.I then go to the benefit/coverage page and am under the assumption that all we have to do is pay the $40 copay. So a couple of weeks later we get a bill for $170.On the benefit page it says $40 copay not subject to deductible.I called them and they gave me some bulls%^t!!! It seems to me they pick and choose what they want to pay. If I would have known that we were going to have to pay out of pocket, we would have waited till the first of the year, since she has to have catscan and surgery also.We pay over $5, 000 a year for coverage and it is thru her employer, so we are stuck with them.We have been with them for quite a few years and have never use it for anything but preventive care ie blood work(lab).I have said it before and I will say it again Insurance Companies are nothing but legalized crooks!!!

In short it has been a nigtmare. Customer service is horrible. I have extended coverage through Cobra now since I was laid off on June 1 and my benefits technically ended June 15th, 2010. I am waiting to have a gastrectomy and pre approval was submitted 6-9-2010 prior to benefits ending. United Healthcare via Sedgwick CMS is now denying it based on coverage termination, however they received the submission from my doctor prior to benefits endidng and the letter clearly states this, the letter dated June 24, 2010 from them which denies the surgery based on criteria, is also wrong. This is their response...
"Rationale: Based on the information provided, the member does not meet all the extensive and rigourous Plan documentation criteria for coverage of obesity surgery(BMI.35 with significant comorbid obesity-related health condition, for at least 2 years; documented ongoing active participation in comprehensive weight loss program for 6 months within the past 2 years), and the proposed bariartric surgery is not covered."

The administrator for United Healthcare and my employer Sedgwick CMS sent me an e mail with the coverage information and criteria, this is not what it states. With my doctor we made sure all the criteria was met.
Aetna Insurance has approved the surgery and has the same criteria, I had had the same situation with Aetna attached is a copy of their intital denial and also the approval after documents were sent. What is difference with Aetna they were polite answered all my questions and expedited it immediaitely. United Health care continues to give it's people the run around.
They reviewed it and sent a denial within the coverage period. I have extended benefits via Cobra and they continue to say that they will not reconsider the surgery or an appeal because I am not covered and until the monies show up in their account they will not consider reviewing it. BAD FAITH if you ask me.
I have spent 2.5 hours o the phone today going from division to division, they place me a hold AND THEN DO BLIND TRANSFERS!!! Please help. This again wa s reviewed within the policy period and the appeals should be considered as such other than that United would be acting in bad faith. I have attached copies of everything