UnitedHealth Group

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

Unfortunately, we are unable to find a policy for her in our system.  Please provide us with her member number and contact information.  You can send the requested information to: UnitedHealthcare[redacted]Minnetonka MN 55343 Or they can fax the information to: ###-###-#### ...

Once we receive the information, we will investigate her issue.Thank you,Debby F - Consumer Affairs Department

I am rejecting this response because:
I DID receive a letter from UHC that stated they already reviewed my original appeal and a decision was previously made. Additionally, I was informed IF I didn't like such decision, I was more than welcome to hire an attorney.
Thus the reason for my original Revdex.com complaint. UHC has made absolutely zero effort in effectively addressing the request of this complaint, nor have they provided additional denial information based on their statements that another "like" medication exists within their policy that may be covered under the paid health plan.
My original request continues with no resolve; I would certainly like to know WHAT medication UHC might be referring to in their statements of denial, so my son's doctor can consider such for his immediate relief. With this consideration and possible provision--if deemed feasible and appropriate by his doctor--I am willing to try said medication, thus working WITH UHC in this matter. If, however, said medication is declined (for medical reasoning outside the scope or knowledge of UHC approval/denial staff that have never even met my son personally) OR medication in question renders no positive effect, I'd ask that higher UHC representatives reconsider this medication for approval on a case-by-case basis for those Customers that have a proven benefit from such. Numerous studies have indicated that Clonidine XR presents positive effects for those children who don't receive adequate relief from stimulants alone. Any non-scholar can perform a Google search and find numerous accredited documents in support. It simply amazes me that Blue Cross would pay for this medication without hesitation, however, UHC won't even consider such on their higher deductible medication tier.
The fact that UHC continues to redirect WITHOUT the provision of such information states much about their lack of care and/or service for their customers. What I'm initially asking for is quite simple, although, seeming hard for UHC to render. I simply need to know; IF they deny Clonidine XR based on their statements that another approved "like" medication exists within their plan, why can't they seem to provide this information?

Contacted United Healthcare on 3/21/16 and was told by a supervisor to get an Eligibility Letter from [redacted], which I already did in 8/2015. Called [redacted], but the agent there was concerned that an Eligibility Letter does not have a policy end date, so sent the Eligibility Letter along with an...

additional letter showing the end dates to the fax number provided to me by United along with a confirmation to be mailed to me.
While speaking with the supervisor at United Healthcare, she revealed to me that United contacted [redacted] on 3/16/16 to confirm that my daughter did have coverage with [redacted] on the start date of my United policy (7/6/15) and used that information to deny claims on 8/6/15 and 8/17/15. United also called my husband on 3/16/15 to ask him if my daughter and I have [redacted] insurance and he said no.
I would like United to tell me why a United employee contacted [redacted] to research their responsibility for claims made on 8/6/15 and 8/17/15 but never actually asked [redacted] if we were insured through them on these dates. I am concerned that these actions are a systematic issue that may be designed to delay payment on legitimate claims and would like to receive comment from United.

March 31, 2016 To Whom It May Concern: We are responding to your recent correspondence dated March 29, 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, Mark [redacted] Consumer Advocate

March 23, 2016
To Whom It May Concern:
We are responding to your recent correspondence dated March 23, 2016, regarding [redacted] Case # [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,
Consumer 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.

August 4, 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 Advocate Mike D.

We have conducted a review of Mrs. [redacted]'s referral history dating back to February 2016. Our records show that we received referral requests on February 8, 2016, February 12, 2016, February 17, 2016, February 22, 2016 and February 29, 2016 for various medical services. Each of these referrals was...

approved and a letter sent to both Mrs. [redacted] and the servicing provider within 24 hours of receiving the request. This response time does meet the TRICARE regulatory time requirement. The next referral requests were received on April 12, 2016 and April 13, 2016. These were requests for Mrs. [redacted] to see an abdominal surgical specialist as stated by Mrs. [redacted] in her complaint. In accordance with TRICARE Regulations, we must try to refer beneficiaries to TRICARE Authorized Providers. If the specialty provider requested on the referral is not TRICARE Authorized, we are obligated to search for a TRICARE Authorized  provider for the beneficiary to see. In this case, Mrs. [redacted]'s Primary Care Provider Henry [redacted] MD, requested an abdominal surgery specialist who is not TRICARE Authorized. We then searched for a TRICARE Authorized abdominal surgery specialist for the referral. During this process we first search for that specialty within a 15 mile radius of the beneficiaries home. If none are found we expand the search to 40 miles and again up to a maximum distance of 100 miles from the beneficiaries home. As stated by Mrs. Avvellan, an error was made initially and she was referred to a hand surgery specialist. This was corrected within 1 business day as Dr. Charles [redacted] was located. Dr [redacted] is TRICARE Authorized and is just over 90 miles from Mrs. [redacted]'s home. Dr. [redacted] did request Dr. [redacted] who is not a TRICARE Authorized provider. Our medical staff within the referral department did conduct a full research to determine if we could refer Mrs. [redacted] to this non-TRICARE provider. There are specific circumstances that will allow us to refer a beneficiary to a non-TRICARE provider. These circumstances include: 1. No available TRICARE provider within radius (100 mile radius), with the specific service type and specialty requested. 2. Continuity of care (This means that the patient was seeing this non-TRICARE provider and sending them to a different provider breaks up the care previously received from the provider). 3. Access to care (this means that the provider referred to cannot schedule the patient within the TRICARE required access to care time standards).  A review showed that Mrs. [redacted] had not received any previous care from the non-TRICARE provider, Dr. [redacted] so there is no continuity of care concern. Also, Dr. [redacted] is within the 100 mile radius and has the ability to provider care to Mrs. [redacted] in accordance with TRICARE standards. As such, we are unable to make an exception and refer Mrs. [redacted] to Dr. [redacted] as requested. We conducted multiple searches for TRICARE Authorized providers with abdominal surgery specialty to see if there are any closer to Mrs. [redacted]'s home than Dr. [redacted]. We did not find any others in the system. However, we do find many other general and trauma surgery specialists as close as 5 miles to Mrs. [redacted]'s home. We cannot make a referral to any of the other surgical specialists closer to her home as the requesting provider was specific in wanting an abdominal surgery specialist. If Dr. [redacted] or Mrs. [redacted] would like a TRICARE Authorized surgical specialist closer to her home, they can make such a request. Mrs. [redacted] can go onto the TRICARE.mil website to view all available surgeon's and submit such a request. We understand Mrs. [redacted]'s concerns and frustration over TRICARE network provider availability. Unfortunately, we are unable to modify the approved referrals as they do meet TRICARE regulations. Thank you

This consumer's issue is in the process of being reviewed.  We will reach out to the consumer directly once there is a resolution for this issue.

Initial Business Response /* (1000, 11, 2015/04/30) */
Re: Revdex.com Complaint Case # [redacted]
Member: [redacted]
Plan Case Number: [redacted]
Dear Ms. [redacted],
We are in receipt of your inquiry dated, April 27, 2015 regarding your request for assistance from [redacted] who 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 Ms. [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 Ms. [redacted] directly. Please note that grievances take up to 30 calendar days and appeals can take up to 60 calendar days.
Initial Consumer Rebuttal /* (3000, 13, 2015/05/03) */
(The consumer indicated he/she DID NOT accept the response from the business.)
I received a phone call from United Health Care and the gentleman I spoke with has been in touch with Optimum RX who claims to have accepted my tier 2. However, I hesitate to consider this case closed. I want to see improvement for other seniors who have to deal with these people, and I want to see if the next order of my prescription goes through properly and smoothly. At this point I have just received promises to credit my account but nothing has gone through.
Final Business Response /* (4000, 16, 2015/05/08) */
Hello,
This member was sent a resolution letter dated May 1, 2015.
Thank you,
[redacted]
Consumer Affairs
Final Consumer Response /* (3000, 18, 2015/05/12) */
(The consumer indicated he/she DID NOT accept the response from the business.)
So far there has been only promises. Nothing has happened. I was told there was a letter sent to my home address. I am away & will not be home until May 20th. I was promised I would see a 115.00 credit on my credit card which never happened. After speaking with the United Care rep. yesterday I was told it would be another 7 to 10 days before it may appear. I know for a fact credit card refunds can be don immediately and will appear within 24 hours. The entire issue deals with Optum Rx which is what I am lead to believe. They will not email me a copy of the letter so I will not be aware of anything they are saying until I return to my home. The credit card is checked daily however. The promise of a refund was May,1 2015. I do NOT consider this case closed! Thank you

May 05, 2017     Revdex.com of Minnesota and North Dakota Attention: Customer Service Department                   220 S. River Ridge Cir. Burnsville, MN 55337 Fax: (651)...

695-2488     Re: Revdex.com Complaint Case # [redacted] Member: [redacted] Plan Case Number: [redacted]   To Whom It May Concern:   We are in receipt of your inquiry dated; April 20, 2017 regarding your request for assistance from [redacted] has been identified as a member of our Medicare Part D 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 [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 Escalations Team who contacted the member about her concerns. If you wish to find out additional information regarding how this complaint is resolved, you will need to contact [redacted] directly.   Sincerely,   Cliff [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 have responded directly to Ms. [redacted]to address her concerns.

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.

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, I have responded directly to the enrollee,...

February 6, 2017.    Should you have any questions or comments, please feel free to call me. I can be reached during normal business hours at ###-###-####.   Sincerely,   Tanya F. Consumer Affairs Advocate

April 18, 2016 To Whom It May Concern: We are responding to your recent correspondence dated April 17, 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 [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,   Kylie D. Consumer Affairs Advocate   [redacted]

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]

I am rejecting this response because:  As I only have 10 calendar days to accept to reject this I have elected to reject it based upon the following reasoning.  My wife has touched base with Jodi from United Healthcare.  Jodi informed her that she would have a disposition by 08/17/2016.  08/17/2016 puts me past the deadline to reject or accept or not reply (which leads to acceptance).  Therefore, until I receive a resolution I am rejecting this.  I have completed the HIPPA form that was attached to the response for use of the purposes to dig deeper into the claims levied against United Healthcare.

I am rejecting this response because:UHC was very helpful buy Briovo is just a supplier.This claim should have been directed toward BriovaRx.I am going to receive $500 from the manufacturer reimbursement program. But no resolution in getting an invoice in a timely manner for the most recent purchase. Their policy is 6-8 weeks after receiving reimbursement from the insurance company. My experience has been 3 to 6 months.

To Whom It May Concern: We are responding to your recent correspondence dated 8/1/2016, 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,Mike D. Mike D.Consumer Advocate