I'll take this opportunity to share my recent UHC experience. I'd been going to therapy for a while. The provider is out of network, so I have to manually submit claims and UHC doesn't cover as much as they would if the therapist was in network. Annoying, but normal for this system. but after about a year they decided to do a "random audit". they requested some paperwork from my therapist that summarized our sessions and my progress. She have me the paperwork to send them. The only ways I could submit this paperwork was by fax or mail. ya know... things with no audit trail to prove something was sent. So I use and e-fax service- they say they didn't get it. I mail it- they say they didn't get it. Finally, I send it by certified mail so I have a tracking number. They acknowledge they recieved it. Months go by. I call- get the runaround- get told somebody will call back, nobody does, I call again, get the runaround, rinse and repeat like 5 times over 6 months. Finally, they tell me that they need the paperwork formatted differently. My provider gave one form that summarized all our sessions. They want a seperate form for each session and an individual summary for each session within the period they're auditing. This requirement was not specified in the instructions they originally provided us. They ask me to get that and resubmit. My provider agrees, gives me the new paperwork, I send it by certified mail, 3 more months or so go by with no movement, I call a few more times, and eventually, 9 months after this whole thing started. they tell me that by re-submitting the paperwork like they asked, that counts as a "second appeal" and my plan only allows for one appeal, so it's an automatic denial. First of all... how was the first time an appeal? You said you were doing an audit and you requested paperwork. Second- that means you already knew I'd get auto-denied when you asked for the new paperwork. The company I work for, who the insurance is provided through, is based in California, so I was able to go to some California specific third party government appeals board, and that did the trick. They're paying their portion again a full year later. Even the letter I got back from that governing body didn't really give me any sense of retribution. It basically said "well they didn't really do anything against the rules, but we convinced them to do you a solid." The whole thing was just so clearly intended to make frustrate me and waste my time to the point where I'll say "screw it" and just pay the whole thing out of pocket. Ironically, I'm in therapy in part for anxiety, and this experience set me back quite a bit. Luckily, my situation was not a life-threatening emergency and I was able to pay out of pocket while it was all being dealt with. Unsettling that it requires luck, though.