I work for a major telecom company who unfortunately uses UNH. A year and a half ago I opted for allergy treatment which UNH states on my benefits summary page is 100% covered.
Three weeks ago my doctor tells me that my claims are not being paid, so I am forced to call the witless UNH customer service reps. After 2 hours on the phone, I finally learn (after much back and forth) that UNH is changing the billing code to “substance abuse” which is not covered.
How they decided that my allergy shots qualify as drug abuse escapes me, but after some explaining they admitted “their” mistake and pay the claims.
Yesterday my doctors nurse calls me again stating that UNH again is refusing to pay my claims. Another hour on the phone and the UNH representative tells me the following.
UNH REP: ” Sorry, but we made a mistake, your employer does NOT cover allergy shots sir. We placed the INCORRECT BENEFITS SUMMARY PAGE on our webpage (www.myunh.com). Sorry.”
I then realized why they changed the medical billing code to substance abuse. Instead of rectifying the problem they simply changed the code so that they would not have to pay the claim. Again, they simply changed the billing code so that they would not have to pay the claim. Thankfully for me I know someone in this medical industry who clued me in on asking about the billing codes, otherwise I would have no clue what went wrong.
So to be exact, my employer never agreed to cover allergy shots, but for some unknown reason UNH provided employees with a benefits summary explanation stating that they do. I can only begin to imagine how many thousands of employees in my company have made important and expensive medical decisions based upon an incorrect benefits summary explanation.
My condition is not that serious, and I can deal with it but what else has been misrepresented. What about a person with a major illness who has been receiving treatment at no or discounted cost only to discover that they now have to pay 100% out of pocket or as in my case pay the deductible (couple of thousand $ for me) out of pocket.
This is simply egregious and unacceptable.
NO COMPANY in the business of human health care should ever be allowed to take their company pubic. Why, because as soon as a company goes public their primary focus is on the shareholder and taking care of their stock price. They are benefiting by cutting every corner and employing every nasty shameful trick to make $$ on our health and well being.
I am all for free market capitalism but I draw the line at my health and well being.
Posted 7 years ago