Wednesday, April 8, 2009

Mad as Hell

I'm mad as hell.

The subject of my rage? UnitedHealthcare.

Years ago, I wrote a report about UnitedHealthcare. It said that UnitedHealthcare routinely refuses to provide members with a copy of their file upon request, prior to filing an appeal.

You see, all UnitedHealthcare policies -- all health insurance policies -- and the federal law known as ERISA require insurance companies to provide, free of charge, a copy of everything on which they relied in making a decision to deny coverage. But when you write to UnitedHealthcare making this request, at best you are ignored, and at worst, they consider it your appeal, thereby depriving you of your appeal rights.

I wrote letter after letter after letter, finally getting in touch with the National Medical Director Dr. Richard Justman. Dr. Justman was kind and thoughtful (and you know I wouldn't admit that if it were not true). He pointed out certain clauses contained in UnitedHealthcare policies, and he assigned a lovely woman to be my UnitedHealthcare contact. So for over two years, when I needed a copy of a file or had some other problem with UnitedHealthcare that I could not resolve any other way, I went to her and she cheerily made sure I got what I needed. And yes, I used this advantage to the benefit of many patients.

All of a sudden, as of this week, my contact is not returning my calls. We had no bad words or anything; the last time I spoke with her, she was handling two matters for me with the same cheery disposition she'd always shown. So I have no idea what happened at all -- not even a clue.

Instead, I got screamed at by someone named Jeff, who's supposed to be a consumer advocate, but I'm thinking consumer advocates really shouldn't be yelling at consumers' lawyers if they want to do their job effectively. Jeff told me that I would no longer be allowed to "circumvent" the process by going to my usual contact. Now remember, I got to her through Dr. Justman, and I wasn't circumventing anything -- I was just using the contact that Dr. Justman had established for me. Jeff told me I should be dealing with customer service first. Remember, I spent at least a year fighting to just get a copy of insurance plan documents before I even got to Dr. Justman. And customer service won't talk to me without a HIPAA release (which is correct of them), but they won't let me fax them a HIPAA release so they can talk to me, so I never even get to answer the question. Jeff said I should write to appeals, and if I don't get what I need, I should write again via certified mail. Does he think a lawyer with more than 25 years of experience doesn't know to send letters by certified mail?

And the two matters he took over from my usual contact? I'll hear back within two weeks -- maybe. In one case, that means a diabetic with gastroparesis can't have her surgery -- even though we won her appeal and UnitedHealthcare agreed to pay for it -- because there's an error in the approval letter that the doctor is afraid will affect his ability to get paid. And I have no recourse whatsoever.

Yesterday, I got a call from a patient who's covered by UnitedHealthcare. She had two identical procedures, one on each hip. They paid for one and denied the second as experimental. In December, she wrote a letter requesting a copy of the documents on which UnitedHealthcare relied in denying her claim. She still has not received a response. Except that UnitedHealthcare construed her request as her appeal, denied it, and told her she has no further appeals. Again, this violates her right under her insurance plan, as well as federal law, ERISA.

So now I'm back to faxing angry letters to Dr. Justman -- until I can find a class action law firm willing to sue UnitedHealthcare for this flagrant violation of law. Because I will not take this lying down. UnitedHealthcare is the biggest, but it's also the most abusive. I was willing to give them the benefit of the doubt when they appeared to be responsive to my concerns, to the benefit of many patients. But if the gloves are off now, if they want war, they've got it.

Now, I start my letter writing again, building a record that will be enough to nail this company. I may be David to their Goliath, but remember -- David won. Jennifer

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