Sean's complaint:
February 19, 2015

Insurance Company: UnitedHealth Group
Coverage Type: Health Insurance

• Claim Handling - Denial of Claim
• Marketing & Sales - Misleading Advertising

My wife and I are covered by a United Healthcare Plan we obtained for 2015 on the Federal ACA Exchange. We had UHC coverage through our employer 2 years ago, and we thought we'd give them a try, as the premiums were lower, and the coverage seemed comparable to the ACA Exchange plan we had last year (with FL Blue).
My wife has been seeing the same doctor since we had UHC coverage, and had an office appointment and lab work scheduled for January, short;ly after we changed to the UHC plan we got through the exchange. About a month later, we received an invoice from the Lab, stating "Your insurance carrier denied payment, indicating the services provided are not covered under your policy". We contacted UHC, and they admit that they denied the claim, and claim that our policy does not provide any out-of-network coverage.
It certainly was not clear to us, nor our doctor, nor the lab, nor anyone trying to discover which service providers are in the UHC network by researching their website, that we would have no coverage and be expected to pay 100% of a services ordered by our physician. UHC receives premiums and exchange subsidies, what exactly are they spending them on? Their only job is to pay medical providers for their services, who thinks it's a good idea to let UHC decide who is supposed to get paid? I was willing to pay some reasonable percentage due the the fact I went to an out-of-network provider, but how can UHC fail to make it clear they will not pay and still be available on the ACA exchange?

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