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Rx Home Care's complaint:
January 07, 2014

Insurance Company: UnitedHealth Group
Coverage Type: Health Insurance

  • Claim Handling - Delays upon Delays
  • Claim Handling - Unsatisfactory Settlement/Offer
  • Claim Handling - Fraud
  • Claim Handling - Denial of Claim

Our agency is contracted to receive a flat reimbursement for each nursing visit authorized. UHC continually refuses to pay the contract rate even when a copy of the contract is presented to them. Further UHC will authorize services under "G" codes yet our contract only provides for payment of "S" code billing. This manufactured confusion has cost our agency tens of thousands each year. Our UHC provider representative has acknowledged this but stated it will not change. As a result each invoice that is sent seemingly pays in a different format with different codes...EVEN THOUGH OUR CONTRACT ONLY CALLS FOR "S" CODE BILLING. To date we have been paid with "G" codes, "S"codes and even PPS episode billing. There is no method to the madness other than delaying and denying the payment to the provider who has already delivered the pre-authorized service. The ultimate goal being to delay the claim long enough to go beyond the timely filing guidelines UHC likes to hide behind when stealing money from its providers. UHC manufactures billing delays and glitches to enable them not to pay their providers and when it is identified they refuse to do anything about it.

Perhaps this practice enables UnitedHealth Group Inc. CEO Stephen Hemsley to make $1,731 for every dollar that a typical UnitedHealth worker made last year.(2011)That puts Hemsley at the top of a PayScale.com study that looked at CEO-to-worker pay ratio for the 50 largest companies in the nation.

UHC represents everything that is wrong with the health insurance industry today. Greed, greed and more greed all in the name of "health care".

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