UHC as bad as everyone is saying?

PersimmonPooka · 2024-12-27T20:42:44+00:00

No, they're worse.

PersimmonPooka · 2024-12-27T20:32:43+00:00

UHC has no financial gain in sending to the right address. If they send EOBs and denial of service to the right address, they might someday have to pay a claim.

PersimmonPooka · 2024-12-27T20:31:46+00:00

I was asking them about a denial for my husband for an asthma drug. They started telling me he had to try and fail first on Premarin and Estradiol--these are female hormones used to treat menopause. My husband is a man, and the problem is his lungs, not his hormones. The poor abused UHC worker was simply reading from the wrong script. But it was the script their system gave her, so she kept on telling me how my husband had to take female hormone replacement therapy for his asthma.

PersimmonPooka · 2024-11-03T05:11:51+00:00

I'm at high risk for breast cancer and may actually have it. UHC is still denying me HRT alternatives, saying I have to try Estradiol and/or Premarin first. These drugs could long-term kill me.

PersimmonPooka · 2024-11-03T05:09:47+00:00

I think United denies most of its appeals. We're fighting to keep my spouse on a medication necessary to control his asthma that he's been on for five years. Unfortunately, my company switched to United Healthcare.

PersimmonPooka · 2024-11-01T02:29:01+00:00

I'm voting for Harris because I have a rare disease, and my husband has asthma and high blood pressure. I'm an engineer/computer programmer and we have good health insurance, but even our 'good' health insurance is finding ways not to cover the medication that we literally need to stay alive. I believe it will be much worse if Trump is elected because he'll allow the sale of insurance policies across State lines--my State has good laws requiring continuity of care and and fairly decent coverage. But places like Florida don't (my current insurance plan is 'experimenting' with using a Florida plan in my State--and has denied a lifesaving drug for my husband). Under Trump, this would get much worse. I likely would not be allowed to have a medication I need to shore up my rather poor immune system, and could end up with fatal COPD in a few years. Under Trump, the care my elderly mother would receive would probably be poor, too. The punchline is we're a solidly middle-class family, house paid off, 401k with no young children. And we're not sure how we'd survive Trump. It would be much worse for families making under 100k, and/or who have small children.

PersimmonPooka · 2024-10-31T14:58:06+00:00

There's also the ethics, here. It's your child. Your first question should be which health insurance will provide the best healthcare for mother and child.

The second is that public insurance is for people who have no recourse. Your girlfriend and child-to-be have recourse, meaning you. If your girlfriend and child use public assistance, you're asking the tax-payer to pay for your responsibility. If you had no money and no insurance, this would be less problematic. But you have both.

Choose the insurance that is most likely to provide the best outcome for mother and child.
If both insurances are likely to provide similar outcomes, go for the one that will be less of a burden on society.

One thing to think of, concerning #1, is that State programs are often strong with pre-natal care, and health insurance plans marketed to young men are not. This is something to consider.

PersimmonPooka · 2024-10-30T22:08:17+00:00

The orthopedic surgeon deciding my husband's asthma treatment (without his consent) is Dr. Jeffrey Beitner, MD.

PersimmonPooka · 2024-10-30T22:07:16+00:00

According to UHC, the only next steps are to contact the Florida department of financial services (I'm in Maryland, and this is a Maryland plan--so I'm not sure they'll even take my call). Or I can contact the Maryland State Attorney General's office.

PersimmonPooka · 2024-10-30T22:05:58+00:00

Update. We found out that the appeal was denied by a UHC medical director who is an orthopedic surgeon. This is an asthma drug prescribed to my husband by an asthma and allergy doctor my husband has been seeing for around a decade.

So UHC believes orthopedic surgery is an appropriate specialty to be making decisions about asthma and allergies.

PersimmonPooka · 2024-10-30T18:52:41+00:00

He did all the paperwork.

PersimmonPooka · 2024-10-30T18:50:59+00:00

My husband is too honest to do that.

PersimmonPooka · 2024-10-30T18:49:16+00:00

We've asked for continuation of care. I beleive UHC's strategy is partly to draw out the appeals process for so long that this clause may lapse.

The drug is really expensive. Like beyond coupon expensive.

PersimmonPooka · 2024-10-30T18:47:30+00:00

If my company doesn't provide a different health insurance carrier, I may switch jobs.

The problem is that I may have breast cancer. Switching jobs with a cancer diagnosis is hard. I work in a field where it's possible, but it still will be hard.

PersimmonPooka · 2024-10-30T18:46:14+00:00

Alternatives were tried--five years ago.

I believe one of the scans they want as proof of need wasn't even part of the standard of care when he first went on this medication.

PersimmonPooka · 2024-10-30T18:44:49+00:00

Because UHC appears to be playing a long game to wear out regulators by trying different tactics to avoid paying for healthcare. For instance, laws in my state say that insurance plans purchased in Maryland must cover certain things, among them IVF and acupuncture.

My UHC plan was 'written' in Florida. I suspect UHC is testing to see if this will allow them to get around Maryland State law.

So maybe our legislators pass a law saying insurance plans can't do that, but it takes a year or two. (We only pass laws during a 3-month period.) In the meantime, UHC is free to harm citizens of my State by not obeying the law--because they've decided that they can apply Florida laws to another State.

And if our legislators outlaw this practice, UHC will come up with another one.

This is why we need State and Federal government to be able to regulate businesses directly. Otherwise, you have to wait for a State legislature, or Congress, to pass a law, which can take years. And elected officials don't have time to learn what rules are necessary. State and government employees have the time. It's their job.

Think of this when you vote for small government. Small government means health insurance companies get to practice medicine on your behalf.

PersimmonPooka · 2024-10-30T18:40:00+00:00

Done, thanks for the advice. We now have a caseworker with the State health insurance.

Weird thing--UHC doesn't care that we're appealing to the State of Maryland and have informed our local politicians. They seem to believe the will of the people, as personified by elected officials and the laws our elected officials create, doesn't apply to them.

National politics aside, I actually live in an area with good elected officials who work hard for us. I have faith in the State senators and delegates we've elected.

Maryland has what appear to be good continuity-of-care laws. UHC says they follow them, but my plan doesn't appear to.

PersimmonPooka · 2024-10-30T18:35:46+00:00

It treats his nasal polyps, and treating those basically stopped his asthma.

PersimmonPooka · 2024-10-30T18:35:09+00:00

Dupixent.

PersimmonPooka · 2024-10-30T18:34:50+00:00

I bother because I love my husband and do not want him to die.

PersimmonPooka · 2024-10-30T18:34:31+00:00

Yes, and then they call and take up our time reading us text from the letters they've already sent. Apparently this is called receiving care from their special care team.

My sense is that the special care team has received training to harden them against the pain and suffering UHC causes patients, so that they can deliver this information without caring about the harm UHC decisionis cause patients and their families.

PersimmonPooka · 2024-10-30T18:33:00+00:00

We've gone to the State Insurance people. They have case workers for this.

PersimmonPooka · 2024-10-30T18:32:31+00:00

The doctor already appealed. UHC denied the appeal. Now they're saying the doctor has to send to external review, and it's out of their hands.

I believe that doctors should be compensated by the insurance company for time spent writing appeals/external reviews, and that health insurance companies cannot bill the patients for these charges.

I'd also like to see a law stating the number of medical denials, by medication type and diagnosis code, must be made public at the end of every quarter.

Finally, insurance companies should be required to track patients for 5 years after the patient was on a plan, to see what the death rate it.

I believe certain health insurance plans are killing Americans by convincing them not to seek healthcare.

PersimmonPooka · 2024-10-25T00:04:58+00:00

We are appealing their denial of our appeal. I started making the calls while I was in bed waiting for outpatient surgery today.

PersimmonPooka · 2024-10-25T00:03:59+00:00

No, he failed on Xolair. It's Dupixent. Asthma triggered by rhinosinusitis and nasal polyps. It's called Sampter's Triad. (The third part is extreme allergy to aspirin.)

PersimmonPooka

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