A colleague working in the managed care industry purchased a HSA plan through United Healthcare/Golden Rule. This colleague, a highly experienced and very knowledgeable industry veteran with extensive expertise in assessing physician outcomes and inpatient and outpatient hospital costs and quality, and several years’ experience in provider network development and operation, was confident in his/her ability to effectively reduce costs while obtaining care for the family.
Not so.
United, which recently released a glowing report on its consumer-directed health plan results, evidently has some fine print in its HSA policy language that is so fine it is invisible. According to my colleague, a dependent received care that cost less than the deductible amount, resulting in a bill for about $800 from the provider (contracted under UHC), which was repriced to about $250 by United. When the colleague tried to pay the $250, the provider refused to accept the payment, stating that the amount owed was the billed charge of $800. Colleague then went to United to ensure the provider was under contract at the time of the service, which it was.
Here’s where it gets slimy. UHC then informed said colleague that as the care was provided outside of UHC’s liability, that the colleague’s liability was, in fact, billed charges. Questioned on this, the UHC representative stated that their provider contracts do not require the provider to accept the contracted rate for services rendered that are not specifically payable by UHC. (I may have the wording slightly off, but you get the picture.)
Colleague, was, as one can imagine, puzzled, s/he went back and read through the entire policy language, EoB, statement of benefits, and marketing literature.
Nowhere in any of those documents could s/he find any reference to this “policy”.
One of two things is occurring here. It is possible that the UHC rep is misinformed, in which case shame on UHC for not training their staff on something as critical as this. And for not training their providers as well, who also stated that their contracts allowed for requesting payment at billed charges under these conditions. That would make the most sense, as it is hard to fathom why UHC would engage in a policy that will obviously result in so much consumer dissatisfaction.
Now it could be that s/he, despite being a highly educated individual, with 15+ years experience in managed care, missed this crucial language in their plan documents. I don’t believe that’s the case, but that possibility actually makes a critical point. If s/he missed this, than 99% of the consumers buying into this plan will certainly miss it as well.
Actually, there’s the worst case, which is UHC didn’t even think about the possible negative implications of their “policy” regarding this scenario.
Meanwhile, CalPERS, the retirement system for many of the state’s retirees and a good chunk of present employees, has brought suit against UHC, alleging that the giant health plan’s policy of retroactive dating of stock options cost CalPERS upwards of $20 million in reduced stock value. This policy was likely partially responsible for providing stock options ultimately worth $1.6 billion to CEO Bill McGuire.
Thisis very revealing.Thanks for doing the homework.
what did the individual eventually pay, and if the higher amount what is s/he doing about complaining? to UHC? Some regulator?
I’d like an upsate too – I’d like to know how this washed out. The chief benefit of health insurance (besides protection from bankrupcty related to catastophic illness) for my fanily, when considering what we are out of pocket for premiums, is the negotiated discounts for care.
We’ve considered HSA’s recently.
I’d always wondered if HSA’s applied those plan discounts to contract provideres or if we’d suddenly be paying triple for the same services.
The former makes sense if the insurer wants to stave off the day it’s obligation to cover services kicks in. If I pay contract rates out of my own pocket, obviously the insurer itself pays nothing for a longer period of time, if it ever pays anything in a given year.
I had a total rt knee while insured by UHC, and they didn’t start paying the bills until I started screaming several months later. I was told by a member service rep that they were instructed not to pay bills over $400.00 until patients start complaining! Eventually, UHC did pay all covered bills.
It’s stuff like this that has me virtually convinced that when UHC said in their study that “costs went down 8% for those with HSAs and went up 11% for those with PPOs” or whatever the exact numbers were, they meant “United Healthcare’s costs went down 8% among those with an HSA”. I’d be shocked if overall spending changed that much between the two plans. It’s just that more of the cost was shifted to the consumer.
Which is why their study wasn’t peer-reviewed, because we all know it would likely have been laughed out of Health Affairs if they’d submitted it.
Pretty scary. And hopefully, pretty wrong. I just got off the phone with a Golden Rule customer service representative and got a completely different (but equally enlightening) answer. UHC network providers are prohibited from “balance billing” for any procedure that is “covered” under the terms of the policy. This $800 procedure, assuming it was covered by the policy, would count $250 towards the deductible and, correspondingly, the doctor would be prohibited from charging any more for this service. (Hopefully this is the right answer.)
Now for the enlightening part… Many individual high deductible plans have policy exclusions that may be unfamiliar to someone coming from group coverage (i.e. physicals and other preventative procedures). I was informed by the Golden Rule representative that in these cases of “excluded items”, the network provided does not have to accept the adjudicated amount and is perfectly within their rights to “balance bill” the patient. As you have said in your posts before, “caveat emptor”. It seems to me that an informed consumer must gain agreement from their provider to accept the network price for an “excluded” procedure before the time of service. I would be interested if this is peculiar to UHC networks only or does everyone operate this way? (because it sure diminishes the value of being on a UHC network plan!)
Can this also be happening with other vendors? What about their Oxford unit? Are they doing the same?
Very interesting. I would recommend that your colleague contact his/her insurance agent and have them work it out. Agents can get a hold of higher-ups at a carrier and get the mess sorted out. If they bought the coverage without an agent they still may have some recourse. They can probably get their policy assigned to a particular agent of choice and thereby utilize the agent’s service capabilities. I have been in the health insurance business for almost 10 years and I would never dream of buying health insurance without an agent. There are just too many ways that things can get messed up – good agents will prevent or at least correct issues as they occur.
Related by slightly OT, most providers have absolutely no idea how to work with people that have HDHP’s or HSA’s. A friend of mine once spent about 20 minutes arguing with a provider’s receptionist that she did not have to pay a $20 copay.
Thank you for the very interesting information you have all been posting about UHC. I work for Whole Foods Market and have their coverage which has already denied a full CAT scan or equivalent procedures deemed necessary by my UHC-approved-Doctor to evaluate my medical condition…instead I will be having one scan at a time which is lunacy, not to mention insanely expensive. My billing has been essentially as muddled as what you are stating…last year I PROVED I had been overcharged (and indeed, I had OVERpaid but was NOT reimbursed!) and I am sincerely at a point where I believe they figure we are all such hard workers and time consumed that we will eventually simply give up and allow them to continue to take advantage of us with such instances as what you have been talking about.
Thank you for letting me vent away :)
Jessie
a clarification. the services were for emergency procedures – a CAT scan for a dependent with a potential head injury and the services associated with cleaning and stitching up the wound.
These are covered services under any policy language.
It appears that UHC’s position is that their contracted rates only apply when it is their financial liability.
Any additional information on this is most welcome.
This is from a conversation w my colleague, the source of the original post.
Wow…John Frederickson who contacted Golden Rule has it correct. In my situation, emergent services at an after hour pediatric care center is not considered a covered service under my policy. Therefore it does not apply to my deductible nor would UHC have to pay if I was above my deductible. Therein lies the problem as apparently their contracted providers do not have to accept the UHC rate for non-covered services and this is what they do not communicate to policy holders anywhere either written or spoken. The following is an excerpt from the plan summary brochure:
Preferred Network Discounts
With a Golden Rule insurance plan, you gain access to a quality network of health care professionals and facilities in your area. Having access to our preferred networks can mean substantial discounts in what you pay for your healthcare. The combined buying power of networks on behalf of large numbers of customers can translate into significant savings for you, including covered out-of-pocket health care expenses incurred before you meet your deductible.
In reading this, I can see what they are going to point to, but the last line should read, “Only for covered out-of-pocket…”. The second sentence is the most mis-leading.
it would be really hard to negotiate with a facility given the fact that I was not aware that I needed to as well as that I was attending to an injured child. Actually my spouse was as I was traveling on business. The furthest thing from my spouse’s mind at the time was negotiation of rates. This is why we contracted with UHC.
As for an update, a representative from UHC contacted me on Friday, and will research the issue as the agent I purchased the policy from is no longer employed with them. I hope to hear from them today or tomorrow.”
UHC is horrible. Their customer service does not specific enough policy information to be helpful. I ended up owing hundreds of dollars for surgery that was only covered at 80% when they told me 4 times it was covered at 100%. I did not find out until the bills came in.
Hi,
I applied last week for a UHC HSA 100 plan. After reading all the horrible information about UHC & Golden Rule, I am now wondering if I should apply with another company. Is there a better HSA plan available? Should I avoid an HSA altogether in spite of the tax advantages?
My family and I are on terrible United Healthcare medical COBRA insurance. After our newborn daughter was born in June, we notified them by phone two days after the birth and requested that she be put on our policy. They said that they need proof in the form of discharge papers or birth certificate. Since with the birth of our other children the discharge papers were not required, they were misplaced during the chaotic time after coming home from the hospital. The birth certificate came a few weeks later with an error in the names. So after receiving the corrected birth certificate (2 weeks later) from vital statistics of the city and promptly faxing it to UHC, they said that it was 4 days past the 30 day deadline for adding a newborn to our policy. We didn’t fax the inaccurate birth certificate to UHC for fear of corrupting our newborn daughter’s identity records. On top of this I was still in my 45 day open enrollment period in UHC COBRA. They are refusing to add our infant daughter to our policy and we are beginning to get ridiculously high bills from the hospital and pediatrician. UHC personnel gave me weeks of run around on the phone, saying they would call back with their response to add our daughter. We never got a call or email from UHC about adding our newborn to our medical policy. After talking to a rude and belittling supervisor, they said they finally gave me a straight answer that they would not be adding our newborn to our policy. So now our infant has no medical insurance, how about that for modern civilization and government in which my taxes go to give medical treatment to criminals and terrorists. I think that UHC is not a company that respects a family, or the difficulties and stresses at the time of a birth. Does anyone have any advice as to how to fight this unfair treatment? Do I have a legal leg to stand on or has UHC screw me again? I think United Healthcare Insurance company has a whole department dedicated to finding new ways to cause hardship to a family, especially the middle class families that probably are not wealthy enough to hire lawyers to fight their unfair policies.
I have dealt with United on a professional basis and can tell you it is one of the worst corporate entities out there. How the government hasn’t investigated and shut down this company, I’ll never know. The irony is that Donna Shalala, the Secretary of Health and Human Services under President Clinton, sits on United’s board of directors and was appointed by President Bush to investigate the bad medical treatment of Iraqi war veterans.
As a NY State employee I was forced into the United Healthcare plan. I live in PA and UHC will not recognize it’s own network physicians in PA as “participating”. Absolutely insane but the worst is NY officials are doing nothing! They are bought and paid for.