UnitedHealth Group

Initial Business Response /* (1000, 5, 2015/09/29) */
We are responding to your recent correspondence dated September 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.
Initial Consumer Rebuttal /* (3000, 7, 2015/10/02) */
(The consumer indicated he/she DID NOT accept the response from the business.)
United Health Care never contacted me regarding this issue. This is a recurring issue and it happened again. I request United Health Care to call me immediate regarding the permanent resolution.
Final Business Response /* (1000, 10, 2015/10/05) */
A letter from United Healthcare Appeals Committee was sent to[redacted] regarding and addressing his concerns on September 29, 2015.

March 10, 2016
Revdex.com of Minnesota and North Dakota
Attention: [redacted]...


2706 Gannon Road
Saint Paul MN 55116-2600
Fax: (651) [redacted]
Re: Revdex.com Complaint Case # [redacted]
Member: [redacted]
Plan Case Number: [redacted]
Dear whom it may concern,
We are in receipt of your inquiry dated; March 2, 2016, regarding your request for assistance from [redacted] has been identified as a member of our Medicare Advantage Plan (MAPD). 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

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.

April 19, 2016To Whom It May Concern:We are responding to your recent correspondence dated April 11, 2016, regarding Mr. [redacted].OptumRx was in contact with Mr. [redacted] on April 14, 2016, and addressed his concerns with a positive resolution. Please consider this matter closed at this time.Should you have any questions or comments, please feel free to email us at [email protected],Suu [redacted] Consumer AdvocateNOT ICE: 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.

December 1, 2016     To Whom It May Concern:   We are responding to your recent correspondence dated November 30, 2016, regarding Ms. [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,   Mark L. Consumer Advocate

To Whom It May Concern:   We are in receipt of your inquiry dated; April 5, 2017 regarding your request for assistance from [redacted] has been identified as a member of our Medicare Advantage Prescription Drug Plan (MAPD).  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 [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.

Initial Business Response /* (1000, 10, 2016/02/04) */
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 800-842-2656.
Sincerely,
Linda **
Consumer Affairs Advocate
Initial Consumer Rebuttal /* (2000, 12, 2016/02/12) */
The consumer indicated that he/she ACCEPTED the business response.

Initial Business Response /* (1000, 5, 2015/10/20) */
October 20, 2015
Revdex.com of Minnesota and North Dakota
Attention: Taylor Keate, Mediation Coordinator
220 S. River Ridge Cir
Burnsville, MN 55337
RE: [redacted]
Dear Ms. Keate:
I am responding to your recent...

correspondence dated 10/19/2015, 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 952-936-1982.
Sincerely,
[redacted] Seifert
Consumer Affairs Advocate
Final Business Response /* (1000, 7, 2015/10/29) */
Per Faxed Information from the business: "Thank you for you letter dated October 19, 2015, oh behalf of Mr. [redacted].
Due to privacy concerns, we are unable to provide more detailed information to you without a signed Authorization to Disclose Information from Mr. [redacted]. However, We have responded directly to Mr. [redacted] addressing his concerns.
Should you require additional information please feel free to contact me by phone at (XXX) XXX-XXXX ext XXXXX or at [redacted]@unitedhealthone.com.
Sincerely,
Robbin [redacted]
Senior Appeals Representative

Initial Business Response /* (1000, 8, 2015/06/29) */
I am responding to your recent correspondence regarding Kathleen [redacted]. Due to the protections of the Health Insurance Portability and Accountability Act (HIPAA), I am unable to respond directly to the Revdex.com 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 once the matter is completely resolved. I want to assure you that this matter is currently being investigated by the claims team within UnitedHealthcare.
Sincerely,
Rhiannon F.
Initial Consumer Rebuttal /* (3000, 10, 2015/07/03) */
(The consumer indicated he/she DID NOT accept the response from the business.)
No one has bothered to contact me on behalf of United Healthcare, as is the crux of the problem. It is ridiculois that each and every month for years on end my healthcare premiums are paid but I can't get a covered expense paid, nor can I get anyone to answer my questions.

Initial Business Response /* (1000, 10, 2015/10/05) */
I am responding to your recent correspondence dated October 4, 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 800-343-4227 extension XXXXXXX.
Initial Consumer Rebuttal /* (3000, 12, 2015/10/06) */
(The consumer indicated he/she DID NOT accept the response from the business.)
They called to ask if I wanted a visit and did not mention the gift card. Therefore I do not accept their response.

This message is to confirm receipt of Ms. [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].

Initial Business Response /* (1000, 5, 2016/01/19) */
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] ext [redacted].
Sincerely,
Tanya
Consumer Affairs Advocate
NOTICE:
Initial Consumer Rebuttal /* (3000, 7, 2016/01/21) */
(The consumer indicated he/she DID NOT accept the response from the business.)
This response is unacceptable. Since I filed my claim, the following has occurred: I received a message from someone in the office of the last rep I spoke with, indicating that if I had any questions, I should call the # on the back of my insurance card. Which means beginning a new dialogue with someone unfamiliar with this issue. While a file # was given to me to share with any rep, it's not the same as follow up with someone that I spent an hour on the phone with. When I called the # listed in the response, I was not given the chance to enter an extension; the only option was to leave a message. I had no idea who I would be leaving a message for so I did not. I then called the # on my card and got a rep on the phone. He looked up the file # I was given in a message from the last rep I spoke with prior to my complaint. He mentioned the file was lengthy and shared some information with me. That information referred to the second claim, which was actually processed correctly. It was the first claim (March 2015) that is still not resolved properly. I am appalled at how I cannot speak with the last rep, who specifically gave me her direct number in case I had further questions. It's also deplorable that I had a message to call the number on my card. Which means spending yet another conversation recalling the entire issue, with yet another, different rep. UHC is acting in a most unprofessional manner, and is not following up with what I was told numerous times with regard to reprocessing the first claim as if it were in network/in contract. I just got off the phone with another rep (after calling the generic # on my card) and he couldn't help me. I asked to speak with a supervisor but they were busy and he assured me I'd get a call back in a day or two. I cannot express my frustration over this matter. I kept being told by UHC that the March claim was processed incorrectly; that multiplan shouldn't have been used, that it should've been processed using IN NETWORK or CONTRACTED rates which are very different from multiplan. I was told it numerous times I was correct, it would be redone and I would hear back from whomever I spoke with. Neither has happened!
Thank you for your assistance.
Final Business Response /* (1000, 23, 2016/02/17) */
February 11, 2016 I made direct contact with the member to address their concern

I am rejecting this response because:
I don't see a letter from the business or a response. They called me from a number that I could not return a call from the number. a guy called me and left a number and 7 digit extension.  The extension was wrong. some lady answered the phone and ask me all kinds of questions that I could not answer because I was driving. I had to wait until I got off from work because no one know that I am sick. She transfered me back to the main number. I spend 3 hours on the phone trying to fix this issue. The drug and United health care should communicate. I am not a insurance drug guru. Are they trying to make me have a heart attack. My issue is not fixed.  I need my medicine.

September 30, 2016   Revdex.com Attn: [redacted] 220 South River Ridge Circle Burnsville, MN 55337   RE:   [redacted]:   Dear Ms. [redacted]:   I am responding to your recent correspondence dated September 26, 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 respond directly to this member regarding this issue. He reports the issue has been resolved.   Should you have any questions or comments, please feel free to call me.  I can be reached during normal business hours at ###-###-####.     Sincerely,  Jeff [redacted] Consumer Affairs Advocate

March 22, 2016
Revdex.com
Attn: [redacted]
220 South River Ridge Circle
Burnsville, MN 55337

RE: [redacted]:
Dear Ms. [redacted]:
I am responding to your recent correspondence dated March 17, 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 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 ###-###-####.
Sincerely,

Jeff [redacted]
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 [redacted] Consumer Affairs Advocate

I am rejecting this response because:
On 3/13/18 I received a call from Angie [redacted] at United who was surprised that I had submitted this dispute as she thought that my claim would have been reimbursed by now.  She promised to follow-up.  But to-date, I have not heard that my claim has been received, authorized and approved for reimbursement.

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.

April 25, 2016 To Whom It May Concern: We are responding to your recent correspondence dated April 14, 2016, regarding Mr. [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, Mark L. Consumer Advocate [redacted]

UnitedHealthcare will be working directly with the member to resolve this issue.