United Health Care / United Behavioral Health / Difinity Health, Constantly gives you the run-a-round about unpaid claims/Makes it difficult to get action. Salt Lake City Utah

but your " good and qualifed postal worker " isn't as good as you'd like to think. 19107 is indeed the correct zip code for UBH in Phila. 10107 is a Manhattan zip code. Perhaps a few seconds on Google and you would have made that discovery yourself. 

I am a provider of Mental Health Services and agreed to a Non Participating Provider agreement with UBH for one of my consumers. I took the rate at a fee which was less than my fees and was issued the contract. I submitted billing according to my experience and my claims were rejected. I spent hours on the phone waiting and waiting until a very nasty incompetent woman came on the line and continued to berate me for not filling in the fields correctly. I asked her to tell me line by line where the errors were and she became belligerant. I asked her to create a claims form CMS 1500 template and provide codes etc to correct the errors and she put me on hold for another hour and then disconnected me. I called back and asked for a supervisor and was again put on hold and disconnected. I sent a certified letter rejecting the non par and enclosed a detailed invoice for services rendered with the notation that if not paid within 30 days, I would file suit with an attorney or a debt collector [though I dislike them]. I indicated I would not participate in treatment reports with them any longer, accept their calls or accept any other non pars. I received a partial payment of 395.00 approxmiately 30 days later. They still owed me approximately 450.00 in claims which I am going to write off. I made an outside arrangement with the consumer regarding a lower copayment to avoid dealing with UBH. I agree, I think they intentionally decline the claims so you get frustrated, it buys them time and they think you will completely walk away...

I had a similar experience with UBH in 2007. They kept giving me the run around this provider is out of network (even though I had an approval letter) or we will resubmit your claim and it will be paid within two weeks, etc, etc, etc. I finally had to involve the New Hampshire Insurance Commission. It still took a couple of more months, but my claims were finally paid in Spring 2008 for various visits starting in Spring 2007 and various visits throughout the year. I had to stop going to my provider, because seeing all this unpaid balance gave me more stress than what I was getting counseling for! I threatened to continue to pursue it further unless they sent me a formal letter of apology, so they did! This is so completely unfair, they take advantage of people seeking help!

NOW THEY'RE DOING IT AGAIN!!!

In Sept. 2008 I started going to my provider again, got a preapproval document and they're pulling the same thing again. My provider is clearly IN Network on their site, I have a letter from them stating he is, but the keep telling me he's out of network! This time I am involving the HR dept. at my employer, and if they can't help I will go back to the NH Ins. Commission. There needs to be a stronger watchdog agency to protect Americans against insurance companies that are behaving badly; AND punish them severely in addition to making them pay the bills!

I had a similar experience with UBH in 2007. They kept giving me the run around this provider is out of network (even though I had an approval letter) or we will resubmit your claim and it will be paid within two weeks, etc, etc, etc. I finally had to involve the New Hampshire Insurance Commission. It still took a couple of more months, but my claims were finally paid in Spring 2008 for various visits starting in Spring 2007 and various visits throughout the year. I had to stop going to my provider, because seeing all this unpaid balance gave me more stress than what I was getting counseling for! I threatened to continue to pursue it further unless they sent me a formal letter of apology, so they did! This is so completely unfair, they take advantage of people seeking help!

NOW THEY'RE DOING IT AGAIN!!!

In Sept. 2008 I started going to my provider again, got a preapproval document and they're pulling the same thing again. My provider is clearly IN Network on their site, I have a letter from them stating he is, but the keep telling me he's out of network! This time I am involving the HR dept. at my employer, and if they can't help I will go back to the NH Ins. Commission. There needs to be a stronger watchdog agency to protect Americans against insurance companies that are behaving badly; AND punish them severely in addition to making them pay the bills!

I've had very similar problems! After filing two appeals and having them denied, I filed a final Voluntary External Review. They were supposed to respond within 30 days. I faxed and mailed (certified mail, return receipt requesed) that on January 12, 2009. I have fax confirmations and return receipts for all appeals. I have spent 25 plus hours on the phone, faxing, mailing them, etc. It seems every time I call I get dumb and dumber on the phone. No one can give you a straight answer.

So, I called today about my lastest (and last) appeal. The rep, Joseph, said he'll email the "coordinator" and doesn't know why I haven't received a response. However, today I received a check from them for some of my appealed claims. He could provide no information on why I received the check (very insufficient by the way) and couldn't tell me what the remarks codes mean. In addition, I've repeatedly requested that they respond in writing -- still waiting . . . I basically ended the call (30 minutes later) by saying that I plan to file a complaint with the State Insurance Commissioner -- he seemed a bit nervous about that, but I do plan on doing that.

I, too, have BC/BS and have never had a problem with them. In fact, I called them today before I called UBH and they said they do not contract with UBH -- it's the employer that contracted with them. When BC/BS was handling claims (in 2007) it was no problem! In fact, when I complained to BC/BS about deductibles and out-of-pocket (because UBH was not giving them the information they needed), they went back and re-calculated all my claims. I received new EOBs yesterday stating they were paying my providers. Now, my docs have to reimburse me for payments made after my deductible was met. But, my latest documentation from UBS shows "family" and "individual" deductibe and out-of-pocket -- you're either one or the other!

Anyway, I am very serious about filing a complaint with the Insurance Department. In my line of work, I know it goes state by state. I can't figure out who to file with -- I have BC/BS of Illinois, I live in New York, UBH claims are in Utah, UBH complaints are in Philadelphia, PA, and the website has offices in CA. My best guess is that I need to file in each of these states with their Insurance Commissioners. I can't find any information on where they are incorporated. But, they really need to be put out of business.

Did I mention that they claims forms state that appeals should be sent to:

United Behavioral Health
Attn: Appeals Department
100 East Penn Square
Suite 400
Philadelphia, PA 19107

A good and qualifed postal worker brought to my attention that the zip is 10107. The zip UBH uses is an entirely different location. It's been on their claim forms forever -- I wonder if they do this on purpose?

I really would like to get these charletons out of business. Any suggestions are more than welcome!

They were actually my favorite insurance company.

If you have a dispute with any bills, did you send the dispute in writing using their dispute form? I hope so because UH doesn't seem to entertain any disputes unless they are in writing. Another rule with them is this. You must send any dispute in within a certain amount of days from the EOB (I think it's 180 days). If you do not dispute within the correct time period, they automatically deny your claim.

Many doctors/hospitals send in their bills with the wrong billing code. You can either have the doctor/hospital resubmit the bills correctly, or you can dispute directly to UH. I used to do both. I would ask the doctor/hospital to resubmit and also send UH the dispute (with a copy to the doctor/hospital). Every one of my disputes was approved except one because I was past the time limit I told you about earlier. Luckly that bill was only for $19.

One of the biggest problems with the billing procedures is when you go to a hospital that is in-network (usually during an ER visit). While you are there, an out-of-network doctor sees you. You pay the ER the co-pay, then get billed by the doctor. UH has no idea that out-of-network doctor saw you during an in-network claim so UH denies that bill stating you have not reached your out-of-network deductible. When you dispute stating the reasons you saw that doctor due to an in-network visit or procedure, and paid the co-pay or in-network deductible, they usually pay the claim.

Also, many times the out-of-network doctor would rather your insurance company deny their bill because they can bill you for more money than the insurance company is willing to pay them. It can backfire for them if you do not have the money to pay. Doctors/hospitals are not very good at resubmitting the bills in a timely fashion.

Their website is myuhc.com to get the info regarding billing disputes. I think the procedure is also shown on the back of the EOB.