UnitedHealth Group

Initial Business Response /* (1000, 5, 2015/04/28) */
April 28, 2015

RE: [redacted]:
Dear [redacted]:
I am responding to your recent correspondence dated April 13, 2015 regarding [redacted].
Due to the protections of the Health Insurance Portability and Accountability Act...

(HIPAA), I am unable to respond directly to you regarding these concerns. Since your letter provided a copy of the enrollee's correspondence and/or a description of the complaint, we will be responding directly to the enrollee.
Should you have any questions or comments, please feel free to call me. I can be reached during normal business hours at [redacted] ext [redacted].
Sincerely,
[redacted]
Consumer Affairs Advocate
NOTICE: This communication may contain PERSONAL and CONFIDENTIAL information and is intended only for the use of the specific individual(s) to which it is addressed. It may contain Protected Health Information that is privileged and confidential. Protected Health Information may be used or disclosed in accordance with law and you may be subject to penalties under law for improper use or further disclosure of the Protected Health Information in this communication. If you are not an intended recipient, you are hereby notified that any unauthorized use, dissemination or copying of the information contained in it or attached to it is strictly prohibited. If you have received this in error, please securely destroy it and immediately notify the sender. Thank you.
Initial Consumer Rebuttal /* (3000, 7, 2015/04/29) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I've gone rounds with this company for over 4 hours and they still won't pay me the money they owe me. [redacted] never reached out to me and never paid me the money due to me. They gave me at least 4 bullet items they needed- I provided everything and they still declined to pay the claim.
Final Business Response /* (4000, 9, 2015/05/01) */
Hello,
A resolution letter has been sent to the member on April 30, 2015.
Thank you,
[redacted]
Consumer Affairs

Thank you for bringing this concern to our attention. Due to the protections of the Health Insurance Portability and Accountability Act (HIPAA), we are unable to respond directly to the Revdex.com.  However, we will be responding directly to [redacted]to address their concerns. ...

Initial Business Response /* (1000, 10, 2015/09/11) */
Unfortunately, we are unable to locate a policy for her in our system. Please provide us with her member id# and contact information. You can send the requested information to:
UnitedHealthcare
9900 Bren Road E
Minnetonka MN 55343
Or...

fax it to: 952-936-3290
After we receive this information, we will investigate her issue.
Thank you,
Debby **
Initial Consumer Rebuttal /* (3000, 13, 2015/09/25) */
Per email with the consumer: "this case is not closed as resolved. I am out of country right now, to reach out and resolve the complaint, please email me at: [redacted]@gmail.com"
Final Business Response /* (4000, 20, 2015/10/13) */
October 13, 2015
RE: [redacted]:
Dear [redacted]
I am responding to your recent correspondence dated October 5, 2015, regarding [redacted]
Please be advised that her issue is being thoroughly reviewed, and we do have her email address on file to communicate resolution. We are still currently reviewing and will provide follow up shortly.
Should you have any questions or comments, please feel free to call me. I can be reached during normal business hours at 800-842-2656 ext. XXXXXXX
Sincerely,
Jenna **
Consumer Affairs Advocate
Final Consumer Response /* (3000, 22, 2015/10/14) */
(The consumer indicated he/she DID NOT accept the response from the business.)
The response does not include a resolution. I have already contacted her. The response does not acknowledge my complaint.

Optum Consumer Affairs responded to [redacted] inquiry on Thursday, March 1st and this issue has been resolved favorably.

March 24, 2016
To Whom It May Concern:
We are responding to your recent...

correspondence dated March 22, 2016, regarding [redacted].
Due to the protections of the Health Insurance Portability and Accountability Act (HIPAA), we are unable to respond directly to you regarding these concerns. Since your letter provided a copy of the enrollee's correspondence and/or a description of the issue, we will be responding directly to the enrollee.
Should you have any questions or comments, please feel free to email us at [email protected].
Sincerely,
Katie [redacted]
Consumer Advocate

Hi [redacted], I have provided resolution to the member on December 9, 2016. If you have any questions please feel free to contact me at 1-800-[redacted] ext. [redacted]. Sincerely,Jodi O.Consumer Affairs advocate

Due to the protections of the Health Insurance Portability and Accountability Act (HIPAA), I am unable to respond directly to you regarding these concerns. Since your letter provided a copy of the enrollee’s correspondence and/or a description of the issue, we will be responding directly...

to the enrollee.    Should you have any questions or comments, please feel free to call me. I can be reached during normal business hours at ###-###-####.     Sincerely,   Jenna B. Consumer Affairs Advocate

I am responding to your recent correspondence regarding Ms. [redacted]. Due to the protections of the Health Insurance Portability and Accountability Act (HIPAA), I am unable to respond directly to you regarding these concerns. Since your letter provided a copy of the enrollee's correspondence and/or...

a description of the complaint, I will be responding directly to the enrollee in writing. Should you have any questions or comments, please feel free to call me. I can be reached during normal business hours at ###-###-####. Sincerely, Rhiannon F.

Due to the protections of the Health Insurance Portability and Accountability Act (HIPAA), I am unable to respond directly to you  regarding these concerns. Since your letter provided a copy of the enrollee’s correspondence and/or a description of the issue, we  will be responding...

directly to the enrollee.     Should you have any questions or comments, please feel free to call me. I can be reached during normal business hours at [redacted]

[redacted] ext XXXXX.     Sincerely,    Jodi O.  Consumer Affairs Advocate

Thank you for bringing this concern to our attention. Due to the protections of the Health Insurance Portability and Accountability Act (HIPAA), we are unable to respond directly to the Revdex.com.  However, we will be responding directly to [redacted] to address their...

concerns. Thank you Consumer Advocate

I am rejecting this response because:
My issue is not with the premium guidelines. My issue is that I was not communicated with by UHC that I was going to have a premium to pay,...

and the letter I received was dated after the effective date. If you review your records, you can see that I attempted to disenroll from the program immediately upon receipt through the online disenrollment form (a method I chose because the representative I was speaking with disconnected me instead of transferring me to the disenrollment department) but I was told that even though the online message said I completed the form, it was unsuccessful. The representative admitted that UHC had been having trouble with its website, so I would assume a system issue, not an error on my end. I did not know this until I got a second bill for February. The two months of premiums UHC says I owe are, as far as I am concerned, fraudulent and nothing more than a way for a company to scam customers out of their money. Contacting CMS will not resolve this issue as it is a billing and communication issue on the part of UHC, not CMS. I request that UHC takes the time to actually review my account and see that I have done everything in my power to disenroll from their program as quickly as possible, but due to a lack of communication and system errors on the part of UHC, I was not able to successfully do this until the effective date of February 28th. The January and February charges should be nullified, and my account balance should be set to zero dollars owed.

I am rejecting this response because:They still never informed me of why they did this to me. That is just bad ratings on their behalf. I will allow this dispute to be closed but syill want my complaint posted against United Healthgroup and AARP. Its a disgrace to do this to elderly on limited income.

Mr. [redacted] received these services while in Afghanistan. United Healthcare does not process claims for services rendered overseas. The TRICARE Overseas contract is managed by the Wisconsin Physicians Service (WPS). We suggest that you contact WPS with question about this claim. They can be reached at ###-###-####, or via regular mail at: TRICARE Overseas Program, [redacted] Madison, WI 53708-8976. Please note that we administer claims in accordance with the TRICARE Operations and TRICARE Policy Manuals. To be eligible for benefits under most TRICARE policies, the claim must be received by the contractor within 12 months from the date of service. In this case, the date of service is in March 2015. We are currently beyond the 12 month timely filing rule found in the TRICARE regulations.  The TRICARE Overseas Program may have a different timely filing rule. We suggest that you contact WPS concerning this matter.  Thank you

December 1, 2017  To Whom It May Concern: We are responding to this issue from [redacted] Due to the protections of the Health Insurance Portability and Accountability Act (HIPAA), we are unable to respond directly to the Revdex.com regarding these concerns. However, we will be...

responding directly to the [redacted] to address their concerns.   Sincerely,  Consumer AdvocateMike D.

October 10, 2016     To Whom It May Concern:   We are responding to your recent correspondence dated October 28, 2015, regarding [redacted].   Due to the protections of the Health Insurance Portability and Accountability Act (HIPAA), we are unable to respond directly to you...

regarding these concerns. Since your letter provided a copy of the enrollee’s correspondence and/or a description of the issue, we will be responding directly to the enrollee.    Should you have any questions or comments, please feel free to email us at [redacted].   Sincerely,   Consumer Advocate

December 15, 2017   To Whom It May Concern:   We are responding to this issue from Mr. [redacted]. Due to the protections of the Health Insurance Portability and Accountability Act (HIPAA), we are unable to respond directly to the Revdex.com regarding these concerns. However, we will be...

responding directly to Mr. [redacted] to address their concerns.     Sincerely,   Optum Consumer Affairs

Thank you for bringing this concern to our attention. Due to the protections of the Health Insurance Portability and Accountability Act (HIPAA), we are unable to respond directly to the Revdex.com.  However, we will be responding directly to [redacted] to address their concerns.

Thank you for your letter dated March 6, 2018, on behalf of [redacted] concerning cancelation of her dental and vision policy.               Due to privacy concerns, we are unable to provide more detailed information to...

you without a signed Authorization to Disclose Information from Ms. [redacted].  However, we have mailed a response today directly to Ms. [redacted], which we believe addresses her concerns.        Should you require additional information please feel free to contact me by phone at ###-###-####, ext. [redacted].Sincerely,Noel [redacted] Senior Appeals Representative

Their response indicates that because of health care privacy laws (HIPAA in particular), they will be unable to respond to you directly and will communicate only with me....

They also write that they can't release benefits data to you, which is not what I am asking about, and also which leads me to believe they still have not engaged with my complaint. I do not want this to be closed out in your 10 day window, because I have little faith that they actually respond to my complaint. It's a no brainer, but their response is emblematic of the dismissive way they have organized customer service. Thank you-[redacted]

Initial Business Response /* (1000, 7, 2015/11/16) */
November 14, 2015
Revdex.com of Minnesota and North Dakota
Attention: [redacted]
[redacted] XXXXX-XXXX
[redacted] (XXX) XXX-XXXX
Re: Revdex.com Complaint Case # XXXXXXXX
Member: [redacted] A [redacted]
Plan Case...

Number: XXXXXXX
Dear Whom it may concern,
We are in receipt of your inquiry dated, November 5, 2015, regarding your request for assistance from [redacted] A [redacted] has been identified as a member of our Medicare Advantage Prescription Drug Plan (MADP). This plan is regulated by the Centers for Medicare & Medicaid Services (CMS). Due to the protections of the Health Insurance Portability and Accountability Act (HIPAA), we are unable to respond directly to you regarding Ms. [redacted]' concerns.
Since your letter included a copy of the enrollee's correspondence and/or a description of the complaint, we will be responding directly to the enrollee regarding their concerns.
United Healthcare has established an appeal and grievance resolution process in accordance with CMS regulations. It is our position, and that of CMS, this process provides Medicare members with adequate recourse regarding any issues they may experience with their coverage, or any other services they received in connection with benefits provided by us. We want to assure you this matter will be investigated and resolved within the CMS timeframes. We have forwarded this complaint to our Appeal & Grievances Department so they can provide a written response to the complainant. If you wish to find out additional information regarding how this complaint is resolved, you will need to contact Ms. Warren directly. Please note that grievances take up to 30 calendar days and appeals can take up to 60 calendar days.
Sincerely,
Travis [redacted]
Regulatory Complaints Department
UnitedHealthcare Medicare & Retirement
Initial Consumer Rebuttal /* (3000, 9, 2015/11/16) */
(The consumer indicated he/she DID NOT accept the response from the business.)
We are not dealing with any confidentiality of health issues here. What we are dealing with is an increase in premiums for a program that was not requested by me. I did not have the same policy when I signed up for this in 2011. Now it is a Medicare Advantage Program with a 50% raise in premiums and I did not ask for it.
Final Business Response /* (4000, 11, 2015/11/17) */
Hello,
Any related information regarding member/patient account or health related issues falls under the HIPAA provisions act to protect the privacy of the member. The plan will directly respond to the member as there is no authorization on file to release this information.