Monday 17th of December 2018 11:12:20 AM
My employer offers voluntary vision insurance and I have purchased this coverage for the past four years at an annual cost of approximately $300. Each time I've incurred vision expenses, I've discovered that the provider I chose was out-of-network. This year I visited UHC's website to learn who was in-network and exactly what benefits I would receive. I had my contact prescription in hand while viewing the website and discovered that UHC offers contacts by mail for a reduced cost. I used a link on UHC's site to the contact provider and was required to acknowledge that I was leaving a UHC site. I arrived at a webpage that read "Welcome United Health Care Members". I made the selection of the contacts that would result in the highest level of reimbursement, 100% coverage for up to a year's supply. I was surprised to find that I needed to provide a credit card for this purchase despite my coverage with UHC and the convenient link between UHC's site and theirs. If I have coverage for 100% of the selected contacts, why wouldn't the online provider receive payment from UHC? I called the number on the website and while on hold I listened to a message stating that independent ophthalmologists could partner with this provider to provide their patients with contacts and receive commission (kick back) on all purchases made by their patients. I thought to myself that UHC was likely receiving some kick back for my purchase but if I receive the same contacts for less cost with the convenience of online ordering, what harm would additional revenue to UHC cause me? When the representative came on the line, I explained my confusion. Why must I use my credit card to purchase contacts that are covered at 100%? The representative explained that I needed to pay for the contacts and submit a claim to UHC. I accepted this as reasonable and paid $180 for a six month supply of contacts and then went to the UHC website to find a claim form. No such claim form existed so I phoned UHC and was instructed to use an out of network claim form and mail or fax the claim to UHC. They processed my claim as out of network at $105 of my $180 expense. I went back to the web pages and on the last page of the contact provider's website (as you are paying), in a tiny font where you would normally find the name of the software/application used to write the website or find trademark details, there is a statement that the provider is out of network with UHC. So much for that convenient link on the UHC site and "Welcome UHC Members". But if that wasn't bad enough, I submitted the claim on 1/30/2014 and still have not received payment. Their explanations/excuses alternate from one call to the next. The first call is "We will issue (or have issued) a stop payment - we can see the check has not cleared. Here is a confirmation number for today's call". On the next call, if it has not been 30 days since the previous call, they say "we have 30 days after the stop payment to re-issue a check. Please wait 30 days and call back". If it has been 30 days or more since my last call, their response is "I see record of your last call but a stop payment has not yet been issued. We'll do that now and issue a new payment. Here is the confirmation number for today's call".I need an Explanation of Benefits to file an appeal of the manner in which they processed my claim - Out of Network. Interestingly, they've revamped the UHC website and there is now a clear disclaimer that the Online Contact Provider is Out of Network. Fortunately, I saved screen shots of the site as I experienced it - only disclaimer in a font of approximately 3 pts. and only on the last step of purchasing (not on a UHC web page). I suspect UHC is not paying vision claims to insureds and I'm certain that many more MEMBERS experienced the same deceptive link between the UHC site and the Online Contact provider. If they save $80 on every claim, plus make some commission on each sale, UHC is collecting quite the little bounty. Even better, from what I am able to tell they simply do not pay claims. I would like to find a class action attorney who needs Plaintiff #1 against United Health Care Vision Insurance.Today when I phoned, I was escalated to a supervisor, Kyron, who asked if anyone has yet explained to me that UHC's recent system conversion is the reason for these delays. I pointed out to Kyron that during their conversion they continued to accept my premiums and therefore had an obligation to pay my claims. Kyron responded that his department just pays claims and has no responsibility for collecting premiums. Wow. Kyron doesn't split atoms in his spare time.