Monday, December 30, 2024

Former Employee: UnitedHealthcare Taught Us Ways to Deny Claims

A former UnitedHealthcare claims representative says employees were systematically trained to deny medical claims and rush distressed customers off phone lines, revealing internal practices at the nation's largest health insurer amid growing scrutiny of the industry.

Posted by LampLighter at 10:31 PM | 10 COMMENTS | permalink

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How #UnitedHealthcare trains employees on how to deny claims #healthcare #healthinsurance

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-- Matthew Taber (@matthewtaber.bsky.social) December 30, 2024 at 5:41 PM

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More from the article...

... Natalie Collins, who worked for UnitedHealthcare for nine months, said Saturday on "NewsNation Prime" that staff received "so many different ways to deny" claims during their two to three months of training, with supervisors often standing behind representatives instructing them on denial methods.

"We weren't given proper instruction to actually pay the claim, and there wasn't enough monies in certain files in certain companies to pay medical claims," Collins said. "We would have to just get the client off the phone as fast as we could."
Health insurance delay tactic' is too common: Former Cigna executive

Collins described crying at her desk while handling calls from desperate patients, as supervisors laughed. ...


#1 | Posted by LampLighter at 2024-12-30 12:47 AM

I worked briefly for a company that contracted with insurance companies to provide the Dr to Dr review for appeals. It became clear during training that the metric for success was to deny the appeal. I lasted one claim and then had words with the supervisor on my way out the door.
They wanted to deny a second day for a 14 year old that was in the ICU for acetaminophen poisoning.
When I would call United to request an appeal it was quite apparent that the person on the other end was quite jaded.

#2 | Posted by mattm at 2024-12-30 10:49 AM

The GoTo move for most of these Advantage companies is to Deny, Deny, Deny. And even then, they don't cover more than about 1 day hospital stays, while original Medicare does.

Even the ACA insurers are making a fortune these days.

Most of the insurance industry needs to dry up and disappear; we don't need them all. What we need is single payer and a model that promotes medical education and degrees for Doctors.

#3 | Posted by Corky at 2024-12-30 11:54 AM

" these Advantage companies ... "

As a former Trustee of a health plan, I always warn people against Medicare Advantage. My mantra: "Advantage plans only advantage the insurer."

#4 | Posted by Danforth at 2024-12-30 12:07 PM

Beware AARP members

UnitedHealthcare Insurance Company is the exclusive insurer of AARP Medicare Supplement Insurance Plans, also known as Medigap.

As the administrator of my mother's estate, I kept getting notices of unpaid bills from her doctor after her death. She was a member of AARP and had her gap insurance with United Healthcare. I had to fight with them tooth and nail to get them to pay the gap insurance.

They were rude, accusatory and at least two supervisors pretended to lose their tempers with me. It took six months of exhausting efforts by myself and the attorney for the estate to finally get them to pay the claim.

As I said above, BEWARE. If you think you've got yourself covered with AARP, you don't.

#5 | Posted by Twinpac at 2024-12-30 11:27 PM

As the parent of a child with specialty medication needs, I lose my temper with insurance companies about once a month, practically on schedule. It has become almost impossible to get claims handled without raising holy hell. I save up all my problem calls, and try to handle them all the same day so I don't ruin the rest of my week. A whole lot of , "please escalate this to your supervisor", and what is your name, so I can add it to my letter to your corporate office".

Somettimes it takes hours on hold just to get past the script reading overseas call centers and into the US. By the time I get halfway into the day, the rage is getting real and you don't want to ---- with me. Full Karen mode on steroids. When I start getting loud,my partner will quietly slip in, delivering chocolate or tequila shots. I don't condone murder, but I can see how Luigi got to that point.

#6 | Posted by Miranda7 at 2024-12-31 12:11 AM

I'm 70. A few months ago my heart was acting weird. After several hours I went to the ER about 4 pm. They quickly ruled out a heart attack or stroke. Protocol kept me overnight. Four doctors later at noon next day doc says more tests stay another night. I said do whatever tests but I'm out at 4pm. They did an ultra sound, I left about 4pm and have had zero problems since. Thirty Seven Thousand F*****g Dollars for that little foray. I keep getting miscellaneous bills for a hundred or so dollars from providers that I have no clue who the f*** they are. I throw 'em in the trash, sue me.

#7 | Posted by et_al at 2024-12-31 01:07 AM

Beware AARP members

UnitedHealthcare Insurance Company is the exclusive insurer of AARP Medicare Supplement Insurance Plans, also known as Medigap.

...

As I said above, BEWARE. If you think you've got yourself covered with AARP, you don't.

#5 | Posted by Twinpac at 2024-12-30 11:27 PM

My wife and I have the AARP Medicare Supplement Insurance from United Health Care and have for nearly nine years and in that time I've had a heart valve replaced, my gall bladder removed, radiation treatment for prostate cancer and most recently, a full joint replacement of my right shoulder. And in all of these cases we've never paid a single penny out-of-pocket. But then we have the so-called 'Plan-F', which they no longer offer but since that's what we originally signed-up for back in 2016, they have to continue to grandfather us in each year. Granted, it might be a bit more expensive but when you consider that there are NO deductibles and NO co-pays, it's been well worth it.

OCU

#8 | Posted by OCUser at 2024-12-31 01:08 AM

If you get a medsup plan with UHC always go with an N plan or a G plan and that's assuming you can't get an F plan.

#9 | Posted by Tor at 2024-12-31 01:59 AM

FWIW C. 2010 The Department of Labor estimates that each year about 1.4 billion claims are filed with the employer-based health plans the department oversees.

Of those, according to data collected from health insurance industry sources, 100 million are initially denied. In simpler numbers, that is one of every 14 claims.

#10 | Posted by Tor at 2024-12-31 12:29 PM

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