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March 13, 2006
HEALTH PLANS: Hey, wasn't UHC supposed be nice now?
Having been the first health plan to say that it was going to stop hassling physicians back in 1999, I thought United was supposed to be behaving itself and promoting love, flowers and puppy-dogs all around with its providers. (Well apart from that quality ranking stuff in St Louis). Well apparently the answer is not exactly not exactly:
The Arizona Department of Insurance on Friday ordered United Healthcare to pay civil penalties totaling $364,750 — the largest fine in the department's history — for violations of state insurance laws. State regulators said United Healthcare illegally denied more than 63,000 claims by doctors without receiving all of the information needed to accept or deny a claim. The company also failed to follow state laws for promptly notifying doctors and patients about about decisions and appeals, the state said. United also violated a 2002 agreement to correct previous violations, the state said.
March 13, 2006 in Health Plans | Permalink
Comments
Matthew- some posts are so revealing, they do not require comment...
Posted by: Eric Novack | Mar 13, 2006 1:48:32 PM
$364,000 as a fine. Wow! That's an amount equal to what their CEO Dr. McGuire makes in 5 hours of work!
Posted by: G. Hinson, MD | Mar 13, 2006 3:16:47 PM
So, what would be nice?
I could imagine one nice scenario:
1) Based on past experience, we find that 75% of this
doc's initially-incomplete claims turn out
eventually completed and valid.
2) Pay the doc 75% of the claimed amount, and ask for
more documentation. Hold the claim
open/suspended/anything-but-denied.
3) If you don't get it, deduct the previously paid
amount from the next check.
3a) For extra credit: use a more complete kind of IBNR
calculation that takes into account the "tail". If
you find out that 20% of the over 30 days claims
are eventually found OK, then only deduct 80% from
the next check instead of all of it. And so on until
step 4.
4) Do adjudication on what documentation you do get.
After a year (or whatever) cancel the undocumented
claims, and deduct the remainder.
What do people think? Is this nice enough?
t
Posted by: Tom Leith | Mar 14, 2006 8:49:48 AM
No, I want puppies!
Posted by: Matthew Holt | Mar 14, 2006 9:58:45 AM
Sure you do! Until it comes time to clean up after him. Then what? Hmmmm?! I bet you give him right back to me.
t
Posted by: Tom Leith | Mar 14, 2006 11:16:55 AM
Tom, it cost me a 20% increase in overhead just to read and understand what it is you're proposing. Way too complex. Remember the KISS principal! I'm with Matthew. Just bring on the puppies.
Posted by: G. Hinson, MD | Mar 14, 2006 2:02:56 PM
You got space in your exam rooms for a puppy? I bet it relaxes the patients...
And don't worry, Subtle Sally will get it. She'll see improved cash flow immediately. There will be great rejoicing. But she will chase you down to get those forms filled in right before the end of the month.
t
Posted by: Tom Leith | Mar 14, 2006 2:54:40 PM
First time commenter - but just experiencing deja vu - it seems United has had this problem for years - they've been nailed for denying claims without sufficient information before - and almost had selected HMO operations shut down due to this in some locations...the claims systems were highly efficient - but often wrong.
Posted by: hcgeek | Mar 15, 2006 9:46:46 AM
Is it true that this past Friday UHC let go of ALL Pacificare's Individual and majority of the Small Group Sales force? How are members being supported?
Posted by: David Ta | Mar 20, 2006 9:12:13 AM
UHC has slashed my physician pathology laboratory fees almost 50% compared to two years ago, they are now paying me LESS than HMO rates for PPO patients (they say it's my "contracted" rate, I never got an updated contract with those reduced fees; when I saw what they are now paying, I felt like I had been kicked in the gut...) AND, over the las two years, they have continually denied claims, and/or failed to process claims correctly; what recourse do we have, I have written the State insurance commissioner (California)--how are we physicians with a small business supposed to survive???
Posted by: Julie Duquette MD | Sep 21, 2006 9:59:22 PM
United Healthcare- I think they should pay the administrative cost for their errors when they become excessive and “abusive to the system”. In September of 2006 United began paying my claims at 100% of billed charges. To NO avail every claim had to be appealed and request that the process at the contracted rate. All of the first appeals show that they paid correctly and to keep the monies. If I were not an honest guy I would have done that and let them find these on their own. 6 months a 300+ claims later they started pricing the claims correctly. Now, even though it is my office making them aware of the overpayments, they are recouping all of the money I am telling them about. Not a problem if in fact I had not previously submitted a refund to them which they cashed and my account was sitting at –0-. Yes the Accounts receivables are out of control as the aging is increasing because I have to bring back and recollect on all of these accounts. To get a live person is an act of congress. When I get the people in another country I am told that they will send a message and someone will get back to me in 48 hours. Not sure what clock they are using but mine shows they are a few weeks behind in their call backs. I have left eleven messages and not a single person has returned my call. I finally did get through to a person (after the 15 minute wait) only to have them pick up the phone, tell me the computers were down, to call back in one to two hours then hung up on me. How nice is that??
Posted by: Rodney Craig | Mar 29, 2007 12:13:37 PM
United Health Care has been playing games with my claims. Everyone has been denied. They are using this tactic to make more money for themselves. If you are thinking of buying UHC insurance don't.
Posted by: bob | May 23, 2007 6:35:41 PM
UHC has many ways to deny claims. Remember if your insurance is provided by your employer as part of the the health and welfare plan, then UHC is only the administrator and exempt from state law. The only way to get payment s for services may be to sue your employer.
Also it appears in my market that the big discounts that are negogiated by UHC actually go right to their bottom line. Your copay should be based on the amt after discount, but what they do is obtain an illegal kickback without applying the discount to lower the co-payment.
This entire setup is just like the entire protection racket in Chicago in the 1920's. These guys will continue to fight for every penny.
I believe it is time to set up a national heal care system without the insurance companies.
Posted by: Jim | Jun 2, 2007 7:54:42 PM
Amazing. One of the big-box home retailers that I recently began working for, with the initials "HD", told me that I could sign up for Health Insurance, even if I only worked 12 hours a week! The provider? United.
This morning, I was blessed to see the commercial promoting the new Michael Moore movie...Sicko... and United is mentioned in the 15 second "Blipvert!" (Yeah I almost exploded when I saw that)
I reside in Massachusetts and a law was passed by Gv. Romney (who's in the presidential race - sorta) mandating all residents to be covered by health insurance. What this is actually doing is causing Health Insurance companies to diversify and roll out individual plans. We all have to be covered by July. I would invite all of you who are interested in following the diversification of Health Insurance for the individual to follow what is happening in Massachusetts over the rest of the summer. And thanks for the comments on United, because I'm going to look up my own policy (and some plans are actually reasonable.)
Posted by: Jill | Jun 18, 2007 7:58:24 AM
UHC is unbelievable. They harass my providers with constant demands for more information and recently, when I checked with one of my providers, they had not received any request for more information. This is for a bill of $800. In one instance they actually called another of my providers and asked...on the telephone...what her phone number was. So far this year I have received no payments, the only communications I have recieved are "requests for more information." Or they have ignored my claims completely.
What are they doing with all this money my employer and I pay for my insurance? Over the years premiums have gone up and service has gone down. We are paying ever more for ever less.
Is there some way for consumers to band together to fight this expensive, unresponsive system?
Posted by: Joan | Jul 13, 2007 10:58:01 PM
I'm with you if any one wants to fight them. I suggest we bombard the call center with calls day and night until they have to pay some claims. They lie so badly, never return calls. Then they tell you to appeal it. I am bypassing the appeal and will call every day until they pay. The people there would get so sick of talking to the same people everyday, they might pay the bills theirself. It's time to fight back- they can hang up on us, put us on hold, then we can call and do the same until they do what they said, pay for the covered services. UHC makes me sick!
Posted by: Mr E | Jul 20, 2007 10:24:47 PM
I have been with MDIPA for over 15 years and I had no problems with them. However this year United Health Care took over MDIPA. Now the problems begin. They call to see if I have another insurance company. They deny claims, the Co-Pays are out of sight, the
cost of perscriptios have doubled. I have a procedure scheduled and I found out last night my Co-Pay is $150.00, I called UHC, they said it is spelled out in my new Policy on the last page of a 20-30 page contract!I should have done some home work before I signed up for another year with UHC/ MDIPA. MDIPA was a good plan before UHC took it over. Is there a good Health insurance company out there?
Posted by: Gene | Apr 16, 2008 4:57:31 AM
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