I have United Healthcare through Medicare. They are awful, but things seem to have taken a personal turn for the worst. I have an insurance navigator who is the only person who handles any questions I have.
My plan offers acupuncture, but there is no in-network providers for more than 100 miles. I filed a complaint because of that which no one has ever responded to. I asked my navigator to file a request to allow acupuncture since they don’t have any providers listed locally. He filed as me needing it for headaches when I needed it for back pain. I believe he did it intentionally because I filed a complaint about the lack of acupuncture providers. I have never spoken to him about headaches, but I have spoken to him at length about my back issues, and have recently been in physical therapy for it. The request was denied based on it being filed for headaches. United only allows acupuncture for back pain which is what I have been getting it for.
Then United denied another provider’s claim, so the provider cancelled my appointment until the claim was paid. I was at the office for the appointment when she told me it was canceled. I called my navigator and asked him to help get it straightened out. I put my navigator in touch with my provider’s billing office. I noticed when I called my navigator I could no longer get through to his line. Only a very select few have access to my info – per several United employees I spoke with so this did create an inconvenience and lasted for days. When I was able to get in touch with him he told me my provider was dropping me as a client because I had been rude to their billing assistant. This never happened – not a cross word was said between us.
The navigator then tells me that the provider’s office has revoked the claims that were to be paid which left me concerned I would be responsible for them. This made no sense to me because one claim was definitely going to be approved and the other just needed to be refiled.
The next day I spoke to my navigator again and he told me he never said the claims had been revoked – he did, and I repeated what he said back to me to confirm – he said the claims had been paid.
I have never heard from United regarding the complaint I filed through Medicare about two weeks ago.
I have strong feelings that my navigator had something to do with me getting dropped by my provider. The story that I was rude just never happened. And he waited to tell me I was dropped. I had to contact him, he never reached out to me to tell me I had ben dropped.
Medicare stated any complaint I file against United will be re-routed back to United for them to handle. That just seems nuts. A company investigating itself. But it would explain my navigator’s behavior.
I have reached out to the Center for Medicare and Medicare Services (CMS). I’m not sure they can or will help me. They just said expect a letter from us in 10 business days.
Does anyone have experience with CMS?
Does anyone have any suggestions on who I can file a complaint with that’s not Medicare?
submitted by /u/Diamondphalanges756
[link] [comments]I have United Healthcare through Medicare. They are awful, but things seem to have taken a personal turn for the worst. I have an insurance navigator who is the only person who handles any questions I have. My plan offers acupuncture, but there is no in-network providers for more than 100 miles. I filed a complaint because of that which no one has ever responded to. I asked my navigator to file a request to allow acupuncture since they don’t have any providers listed locally. He filed as me needing it for headaches when I needed it for back pain. I believe he did it intentionally because I filed a complaint about the lack of acupuncture providers. I have never spoken to him about headaches, but I have spoken to him at length about my back issues, and have recently been in physical therapy for it. The request was denied based on it being filed for headaches. United only allows acupuncture for back pain which is what I have been getting it for. Then United denied another provider’s claim, so the provider cancelled my appointment until the claim was paid. I was at the office for the appointment when she told me it was canceled. I called my navigator and asked him to help get it straightened out. I put my navigator in touch with my provider’s billing office. I noticed when I called my navigator I could no longer get through to his line. Only a very select few have access to my info – per several United employees I spoke with so this did create an inconvenience and lasted for days. When I was able to get in touch with him he told me my provider was dropping me as a client because I had been rude to their billing assistant. This never happened – not a cross word was said between us. The navigator then tells me that the provider’s office has revoked the claims that were to be paid which left me concerned I would be responsible for them. This made no sense to me because one claim was definitely going to be approved and the other just needed to be refiled. The next day I spoke to my navigator again and he told me he never said the claims had been revoked – he did, and I repeated what he said back to me to confirm – he said the claims had been paid. I have never heard from United regarding the complaint I filed through Medicare about two weeks ago. I have strong feelings that my navigator had something to do with me getting dropped by my provider. The story that I was rude just never happened. And he waited to tell me I was dropped. I had to contact him, he never reached out to me to tell me I had ben dropped. Medicare stated any complaint I file against United will be re-routed back to United for them to handle. That just seems nuts. A company investigating itself. But it would explain my navigator’s behavior. I have reached out to the Center for Medicare and Medicare Services (CMS). I’m not sure they can or will help me. They just said expect a letter from us in 10 business days. Does anyone have experience with CMS? Does anyone have any suggestions on who I can file a complaint with that’s not Medicare? submitted by /u/Diamondphalanges756 [link] [comments]Read Morer/HealthInsurance