UnitedHealth Group

I am responding to your recent correspondence dated March 14, 2018, regarding [redacted].Due to the protections of the Health Insurance Portability and Accountability Act (HIPAA), I am unable toprovide you with detailed information regarding the resolution of this issue without authorization from [redacted] to release his private health information to you.UnitedHealthcare has investigated this matter and has spoken with [redacted]. For more informationon the resolution of this issue, please contact [redacted] directly.Should you have any questions or comments, please feel free to contact me directly at###-###-#### during normal business hours (Monday – Friday, 8:00 a.m. to 5:00 p.m.).Sincerely,Nancy [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 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, Nichole L. 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 Mr. Newcomb to address their concerns. ...

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,
 
Jodi O.
 
 
Consumer Affairs Advocate

This message is to confirm receipt of [redacted]'s concerns. Thank you for bringing this matter 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 regarding these concerns. However, we will...

research and respond directly to Ms. [redacted] with the results of our investigation. Should you have any questions or comments, please feel free to email us at [email protected].

Revdex.comI will be appleaing this decision, but thank you for your help

Initial Business Response /* (1000, 5, 2015/09/11) */
September 11, 2015
RE: [redacted]
Dear Ms. [redacted]
I am responding to your recent correspondence dated September 9, 2015, regarding Janice [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 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 XXX-XXX-XXXX, ext. XXXXXXX.
Sincerely,

Christine **
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 [redacted] Rebuttal /* (3000, 7, 2015/09/14) */
(The [redacted] indicated he/she DID NOT accept the response from the business.)
I feel my complaint stands on its merits as written. As of this date, they have not responded. It is my belief they are intentionally trying to avoid paying a legitimate claim.
Final Business Response /* (4000, 13, 2015/09/23) */
September 23, 2015
RE: Enrollee ID: XXXXXXXXX
Enrollee Name: Janice [redacted]
Dear Ms. Keate:

I am responding to your recent correspondence dated September 22, 2015, regarding Janice [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. Thank you for bringing the additional feedback to our attention. As indicated previously, we will be responding directly to the enrollee.
I want to assure you that this matter is currently being investigated by the necessary business segments within UnitedHealthcare. Please be advised that due to the complexity of this investigation, we anticipate being able to resolve this matter by September 29, 2015. We will inform the member once the matter is completely resolved.
Sincerely,

[redacted] Q.
[redacted] Advocate
NOTICE: This communication [redacted] contain PERSONAL and CONFIDENTIAL information and is intended only for the use of the specific individual(s) to which it is addressed. It [redacted] contain Protected Health Information that is privileged and confidential. Protected Health Information [redacted] be used or disclosed in accordance with law and you [redacted] 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.
Final [redacted] Response /* (3000, 15, 2015/09/24) */
(The [redacted] indicated he/she DID NOT accept the response from the business.)
They have yet to reply to my complaint, proving that the heartless and soulless individuals who make up this immoral company does not even have enough integrity to acknowledge when they have screwed up.

Initial Business Response /* (1000, 5, 2015/12/10) */
December 10, 2015
Revdex.com
Attn: [redacted] XXXXX

RE: [redacted] :
Dear Ms. [redacted]
I am responding to your recent correspondence dated December 8, 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 respond directly to this member regarding this issue.
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,

[redacted]
Consumer Affairs Advocate
Initial Consumer Rebuttal /* (4200, 7, 2015/12/21) */
Have yet to receive correspondence from the business. Please call (XXX) XXX-XXXX with information.
Final Business Response /* (4000, 16, 2016/01/12) */
January 12, 2016
Revdex.com
Attn: [redacted] XXXXX

RE: [redacted] :
Dear Ms. Keate:
I am responding to your recent correspondence dated January 6, 2016, 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 have responded directly to Ms. [redacted] regarding this issue and the additional information that is needed from her.
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,

[redacted]
Consumer Affairs Advocate

June 26, 2016
 
 
Revdex.com of Minnesota and North Dakota
Attention: [redacted]
2706 Gannon Road
Saint Paul MN 55116-2600
Fax: (651) 695-2489
 
 
Re: Revdex.com Complaint Case # [redacted]
Member: [redacted]
Plan Case...

Number: [redacted]
 
Dear Whom it may concern,
 
This response is in receipt of your inquiry dated: June 17, 2016, regarding your request for assistance from [redacted]. Mr. [redacted] has been identified as a member of our Medicare Prescription Drug Plan (PDP). 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 Mr. [redacted]’s 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 Mr. [redacted] 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

I am rejecting this response because: UnitedHealthCare did not contact me as they said they would in their response.  I called the number they provided in the response - ###-###-####.  I discovered that this is a general number that wouldn't get me to the right claims person.  I therefore called UHC using the information that was provided to me from my call on April 11, 2017.  I spoke to Sharon, who informed me that the claims had again been incorrectly sent back for processing and that she would have to submit these claims to her Team Lead - Alex - to reprocess.  She gave me a Claim Reference Number #[redacted] which corresponds to the original claim that was reprocessed that shows that my out-of-network deductible of $400 was meet on 01/05/2017.  I have attached the reprocessed paperwork for January 2017 showing that my deductible was met on 01/05/2017.  I will soon be submitting claims for the month of March 2017.  If the same pattern of incorrect processing continues, I can only assume that there is a systemic problem, which would be a surprise for a company as large as UHC which handles so many claims.  This is a very simple case - I have a $400 out-of-network deductible that is clearly stated in my contract.  UHC has used $900 deductible for me at least 6 times even after I pointed out the mistake. UHC even sent me a letter, dated as of April 4, 2017, telling me that UHC had reviewed all claims and the claims were processed correctly.  I have attached the letter.  If I were to have accepted UHC's letter, I would have to stop seeing my doctor because I would be unable to pay him and that would be extremely hazardous to me, even deadly in my circumstances.  I expect that this will receive the attention that it deserves.

A Written Response has been sent.

Revdex.com:
. 
I have reviewed the response made by the business in reference to my complaint. They are not resolving anything except to respond other than the Revdex.com.

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 her concerns. ...

I am rejecting this response because: this is just another attempt to stretch this complaint out as long as possible so I would give up. I want someone from the corporate office, not consumer advocates office to contact me about the manner of which a company they pay OPtumRX 's customer service is so horrible and uninformed that those foriegn employees do not even know where the corporate office is or the corporate phone number. now this is the second issue this year I have had, the first one took almost 3 months to get solved, but this all I get you have to wait 3 5 days to get a call back, going on for over 2 weeks now. I contacted medicare and informed them of these problems and even requested to change commpanies. I cannot believe this company would block a person from using the website for their prscriptions. And I want united healthcares responses  to be submited VIA Revdex.com

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 Ms. [redacted] to address their concerns.

Complaint: [redacted]
I am rejecting this response because: I want the Revdex.com to still be fully involves until this matter is resolved. Thr message only stated that they would contact me. That is not a resolution that is jist simple stalling. So, I will wait for their response, but that is not a good enough answer for me. I haven't been contacted by them yet,
Sincerely,
[redacted]

Dear Mr. [redacted]:
I am responding to your recent correspondence dated July 5, 2017, 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 correspondence and a description of the complaint, we responded directly to Ms. [redacted].
Should you have any questions or comments, please feel free to call me. I can be reached during normal business hours at ###-###-####.
Sincerely,
Tiffany [redacted]
Consumer Affairs Advocate

Initial Business Response /* (1000, 8, 2015/07/07) */
Dear Ms. [redacted]:
I am responding to your recent correspondence dated June 22, 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 description of the complaint, we responded directly to [redacted].
Should you have any questions or comments, please feel free to call me. I can be reached during normal business hours at [redacted] extension [redacted].
Sincerely,
Tiffany [redacted]
Consumer Affairs Advocate

(The consumer indicated he/she DID NOT accept the response from the business.)
The Catamaran/OptumRx representative did contact me by phone on 3/23/16 at ~5 pm Central time. Nothing was offered other than looking into my issues. I will not accept the response until I receive a refund for my...

out-of -pocket expenses for the four drugs minus my appropriate copays.

January 30, 2018  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 AdvocateJulia A.