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Velma's complaint:
January 17, 2016

Insurance Company: AARP
Coverage Type: Health Insurance

  • PolicyHolder Service - Denied Access to Services
  • Claim Handling - Unsatisfactory Settlement/Offer
  • Claim Handling - Denial of Claim
  • General - I feel abused by this company

Have Medicare supplement with AARP Complete Secure Horizons. Called Customer Service to inquire about assisted home care with light housekeeping and transportation.Representative stated with Page 14 Article 5 I would have unlimited services for up to 36 hours a week and 8 hours a day for such. Agency who was already giving home health care with nurse, PT and OT secured the referral from doctor for help in the house (making bed, vacuuming, driving to appointments, social visits) Clerk from Agency called me and said I was not covered because Medicare never covers such. I called customer service number on back of my insurance card which was United Health Care. Representative called agency and spent over 30 minutes telling her how to file claims, and assured me I was covered. So, services began within two weeks. From that time on, the agency stated I was not covered, and United Health CAre denied claims.When I called UHC they told me I was covered but agency did not have correct codes and had to have provider write off. They contacted agency and talked to them while I was on phone, and told them it was covered and they should code the claims correctly. Agency argued, but continued services. This went on from July to November, when agency began to call me for payment and send me bills. I had heart surgery and was unable to do any work for at least three weeks, doctor once again gave referral. Agency sent people to home to help, but said insurance would not pay. I called at least 25 times during those months with always the same answer it was covered and the agency was not billing correctly, and they should not bill me as it was under a contract for the HMO, and I was not to pay them and get reimbursed. Finally in October, I filed a complaint with UHC and I was assured this matter would be taken care of and that I was covered for the services. They would notify the agency to not bill me or call me, and give instructions about how to bill correctly. They never contacted me for results, but three times more every time I received a bill or call, I notified UHC. ONce I received a supervisor who told me housekeeping and transportation was never covered, I was in tears after all the months. I called back to find out who to have my attorney talk to. That representative and at least 9 others assured me I had received the wrong information and I was covered. They told me they had contacted the agency several times but no one would talk to them, so it was sent to a higher level to get resolved. My last contact and their reassurance was December 28,2015. At that time they told me this matter would be resolved and I was not to pay anything like they had sent notices before, and all would be resolved by Jan. 13, 2016. I asked would I receive a notice it was not covered and I would have to pay the $6000 balance by now. They assured me not to worry that all was covered and I would not have to pay anything. If that agency did not get correct codes by then, they would have to have a provider write off.
Even though they said they did not need the invoice numbers and itemized services that were billed, I insisted and gave them all to them. They confirmed each one with me. On January 15, I received a notice from AARP secure Horizons administered by UHC that I had been notified originally this service was denied and was all services from invoices were denied. They would pay $0. I had never been told originally the services were denied, and would have never agreed to the services if that was the case. Furthermore, agents such as Richard, Yvonne, Christina, etc. all told me I was covered and even contacted the agency several times to tell them such as I listened. They even gave me names of other agencies that provided home health aides,as they stated they were disgusted with my agency and their ineptness with filing claims for these covered services. I don't know what to do with this notice, and am sick to think I now owe $6000 which I do not have, and would not have racked up the bill had I ever been told I was not covered, instead of being told I was covered. What is my legal recourse? I am not receiving any services from that agency currently. They only give the same housekeeping help to my husband. But, I do not have the income to pay that huge bill.

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