Report: #502443

Complaint Review: United Health Care - United Behavioral Health - Difinity Health

  • Submitted: Wed, September 30, 2009
  • Updated: Wed, September 30, 2009
  • Reported By: Steve — Mt. Morris Michigan USA
  • United Health Care - United Behavioral Health - Difinity Health
    Salt lake City
    Utah and, Minnesota
    United States of America

United Health Care - United Behavioral Health - Difinity Health PPOM Definity Cofinity Fraud, abuse and retaliation Utah and, Minnesota

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TO:      Michigan Office of Insurance Regulation


RE: Mismanagement of Claims by United Health Care/Definity Health/PPOM  and Target Corporation.


Date: 31 August 2009


To Whom It May Concern:


I am requesting that a formal investigation be initiated into United Health Care (UHC) and the multiple companies under its umbrella including Definity Health and PPOM (PPO of Michigan) and Target Corporation, my former employer. The basis of this complaint is the inability of UHC et al. to properly process claims and causing unreasonable and undue hardship on its subscribers. I have been trying to resolve multiple issues for over three years which have caused devastating financial and emotional injuries to my wife, and myself. These include referral to credit agencies, and countless hours on the telephone trying to fix repeat errors by UHC.


Our experience started in August 2005 when I was hired by Target. At the time the medical insurance company was Blue Cross/Blue Shield of Minnesota (BCBS). In April 2006 Target dropped BCBS and we were forced to switch to United Health Care. Claims handling by UHC was very slow and in August 2006 we began receiving phone calls from health providers stating that UHC rejected claims for my wife as she did not have coverage. We called UHC and Target and multiple other divisions of these companies and after 6 months were told that it was a computer error that had somehow not entered her as a dependant, even though we were paying premiums for her. This error continued to have claims rejected for a year more before it was finally resolved. Each claim had to be reprocessed manually by our then appointed Representative from UHC, Carrie Wolski, with coordination from Targets representative Julie Boser. We paid over $15,000 out of pocket in one year and had to draw on an IRA to pay providers as they did not care that UHC was having computer issues; the providers wanted payment. Wolski stated that this error was not specific to us and that it was sporadic among subscribers.


When my wife was finally added in we also began receiving unpaid claims as UHC had improperly switched the start date on our deductible phase

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