UHC SUCKS!!!!!!

I have been fighting with UHC since February. On January 9, 2004 I went to the surgeon about having the surgery done. On February 9, 2004 I received a letter that they have denied it. My policy clearly states that it is not covered unless "deemed medically necessary by my physician". The surgeon's office immediately filed an appeal. Three weeks after it was sent in I decided to call and see if I could get a status on it. All I got was the run around!!!! Nobody could tell me a thing. The only thing I learned was that they claimed to have never received the appeal. The next day I got a copy of what the Drs. office sent and I overnighted a copy of the information to UHC. Now I have a paper trail to prove that it was sent. When I called again a few weeks later I was met with the same runaround. Again I was told that they couldn't find the appeal. I told them that I have confirmation that they received it and that they better find it because I was sick and tired of the run around I was getting. I spoke with numerous supervisors and still got no answers. Finally, in June of 2004 I filed a complaint against UHC with Illinois Dept. of Insurance. A couple of weeks after I filed the complaint I received a letter from the Illinois Dept. of Insurance with a copy of the letter UHC had sent them. They claim that the appeal was routed to the wrong department. (Now mind you that 2 appeals where sent and they supposedly couldn't find either one!!!!) About a week after that I received a letter from UHC stating that the Certificate of Coverage expired. (Which the policy did, but nothing changed in the new policy. I checked and the wording was the same). I called the surgeon's office to tell them about the letter and the girl was just as furious as I was. The Drs. office called UHC and they said they wanted an updated weight and blood pressure. So I had to go see the surgeon again. The Drs. office sent in the new paper work on July 26, 2004. I called UHC last week to be told that they didn't get the updated paperwork again!!!!!!! This time I had a persons name and number to call. I called the Drs. office once again and they sent it to UHC again!!!!! This is totally ridiculous that UHC keeps conveniently "losing" my paperwork. This should have been approved months ago and I should have had the surgery months ago!!!!

Debra, This is unacceptable. I'm sorry you are having such a hard time with UHC. I also have UHC (self insured) and they didn't give me a bit of trouble. However, that was over a year and a half ago. I have a few suggestions for you. First, go to their website, and find out who the VP of Claims is. Call their office, and file a complaint. Tell them you expect this to be handled according to the Fair Claims Practice Act stipulations. Then, file a complaint with the Insurance Commissioners office. Even if it is self insured, UHC will answer the complaint, and it's a hassle for them. You should also file a complaint with the Department of Labor. It's so frustrating, especially since you did everything correctly. Fight the good fight! Roberta