When it was time to choose an insurance company for my MEDICARE "gap" coverage I called Medicare and worked with an associate for over an hour to establish the correct insurance carrier that would best serve my needs. I have been disabled with Behcet's Disease since 1986. There was a list of medications that I had been on for over five years when I spoke with the Medicare representative about the best carrier for my needs; the focus for my medi-gap was then and now strictly my medication coverage. With Behcets Syndrome the right dose, route & consistency of medications is EVERYTHING for optimal treatment of the disease and my Quality of Life! Taking these points into consideration the Medicare representative moved forward finding UNITED HEALTHCARE as the one who not only had each of my THEN 16 meds “Formulary”. All but one drug (Lovenox injectable) to be in TIER ONE! I signed up right away; even signing up for the EXTENDED HEALTH CARE POLICY to guarantee my meds would suffer no “donut hole” or “gap”. All of this extra care to insure these medications would stay within my very limited budget
Effective January 2009 I received a notification from AARP that two of my medications would stop being offered in Tier 1. One medication was taken off the covered list all together! The two medications that were moved to different TIERS were LOVANOX Inj (moved to 4) and FENTANYL (moved to tier 3…After conversations with my RX and my physician was moved up into tier 2). In approximately one month my Tiers 2-4 medications WILL NOT BE COVERED AT ALL, NO CO-PAY, NOTHING!!
I joined UNITED HEALTHCARE with the guidance of my assigned representative from MEDICARE. Our focus when choosing this plan was solely the importance of my medications and the need to have them “tiered” so I could manage to pay for them and by doing so, LIVE.
I have been on these medications for the over five years and took the United Health Care policy in good faith that they would continue to look out for my best health interests. Three of the drugs I have need for have been “adjusted” on UNITED HEALTH CARES-FORMULARY.
An example of one of these drugs and how the “adjustment” of TIERS equates to money coming out of my very fixed and limited income: The FENTANYL PATCHES give me the quality of Life that I need in order to function. This unfortunately is also an addictive drug so you can understand why I am frightened at this change of TIER. With just this ONE drug I will go from paying $5.00 to $6.00, then $7.00 last year (and the years since I signed with UNITED HEALTHCARE). Now, starting January of 2009 the same drug is $39.00 per month, come JUNE I will have no co- pay at all!! The approximate price of $350.00 per month!! That is just ONE drug out of pocket…ONE of 14 drugs that I am on.( I just wanted to note here that even TIER ONE drugs have gone up to $14.00 a co-pay.)
I feel so very ill looking over my potential drug costs when the “Gap-hole” takes place. If I do without I potentially can die. The Tier one drug increase during this “gap” period as well as the TIERS 2, 3 & 4 changes IS NOT what I signed up for. This issue was made clear when I signed up for my Rx benefits. It is not that I have recently been placed on the medications and I can work with my Doctor to find other formulary replacements…NO, I signed up understanding that my representative understood my need to have certain drugs covered. You signed me up with the understanding of MY RX NEEDS WERE TIER ONE, once signed I have no way to change my MEDICARE coverage.
NOW YOU RETHINK THE TIERS WITH YOUR FORMULARY DRUGS! This is unfair and not what I needed or expected!

My health plan with United HealthCare states that it will pay 80% of "eligible" expenses after $400 deductible. I have weekly outpatient therapy sessions, and my doctor is an out-of-network provider. My plan states it will pay for out of network or in network once I have met the deductible of $400. I have met the deductible, but they continue to deny my benefits and reimbursements. I've called, the representative said they (United persons) were putting in my "old" United account number that I had with a previous employer. She said she corrected it, but recent claims show again I have been denied. I'd like to know if I can take any further action with this - this is my plan through my employer.

Thank you for your consideration

My Plan states:

80% of eligible expenses after satisfying $400 deductible.

Any combination of Network and Non-Network Benefits for Mental Health Services is limited to 52 days per calendar year.

I had to have an emergency appendectomy on 09 October 2007. Was feeling sick to my stomach for about a week, finally the pain set in. Called my doctor, went in, they promptly sent me across the hall to the Surgeon who sent me down to the emergency room and a few hours later I am in recovery with 3 holes in me and my appendix gone. All well and good. Until today. I get my statement from UHC, which is my PPO coverage through my Union. I have an OWED charge of $2, 814.75 out of $2, 900.00. UHC covered $85.27, saying this was a 'reasonable charge' for the services provided. Seems the Surgeon who saved me from a ruptured appendix by about an hour wasn't IN my network. Ok let me understand: I am in gut wrenching pain, I am told 'we have to operate' at a moments notice and I guess I am supposed to ask 'OH! BTW, are YOU in MY network?' What the heck is THAT?! Are you serious?! And oh tell me where I can get SURGERY done for $85.27! I am sure this is the first of more charges. Like I HAD a choice here. I guess I should have asked then said 'Oh you're not? Well I am sorry, no surgery. I prefer to get a very nasty infection from a ruptured appendix that has the potential to KILL me because UHC won't cover this'. Yes I called the 866 number provided on my card and was told the same thing and that 'You have the right to appeal'. REALLY? Wow, thank you SO much, that makes me feel just super. We won't even go into the 2 times I have had to call to get them to pay my pain management Dr for services they said they would cover and had to get mean before they would. What a total crock of BS! You get offered UHC at work, STAY AWAY!! Go with the other plan! Don't end up sorry for your choice like I am right now as I type.

i am trying to contact sister may joseph she contact me regarding job openings in the area of where i live is she legit or not. didn't want to leave her contact information either but no way of contact me she only contacts me when she wanted to can you have her contact me directly so we may talk about the healthplan card i purchased for time being to get by until job opens up. my number is 973-601-7142. thank you for you time.

gina grippa

I have had endless problems with United Healthcare over the past year. They have dropped me from the plan and claimed computer problems. It took 3 months to fix that and get a new card with my name on it. They told my chiropractic office that I didn't have chiropractic coverage twice! I called and they confirmed that I did have coverage. I have filed claims that are still unpaid. Lastly, I just had surgery and they are only covering about half of the physical therapy sessions that are needed for recovery.

I'm not sure why they have the word "care" in their name because it is obvious that they do not give a dam.