UnitedHealth Group

Thank you for bringing this concern to our attentionDue 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

Initial Business Response / [redacted] (1000, 7, 2016/01/25) */ Response letter being mailed to member today 1-25-from UHC Consumer Affairs - Y [redacted]

I am rejecting this response because:Until they respond with the results of the investigation, I will remain unsatisfied I am also a medical doctor [redacted] MD, PhD They may use as much jargon as they see fitI am trained to comprehend it

Due to the protections of the Health Insurance Portability and Accountability Act (HIPAA), I am unable to respond directly to you regarding these concernsSince 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 meI can be reached during business hours at ###-###-#### Sincerely, Nichole LConsumer Affairs Advocate

April 18, 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], Mark LConsumer 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 concernsSince 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 meI can be reached during business hours at ###-###-####

Good afternoon, UnitedHealthcare is in receipt of your inquiry dated, August 11, 2016, regarding your request for assistance from Ms [redacted] She has been identified as a member of our UnitedHealthcare Community Plan This plan is regulated by the Division of Healthcare Finance & Administration 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 UnitedHealthcare has established an appeal and grievance resolution process in accordance with state regulations It is our position, and that of the state, this process provides our 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 state mandated 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 Thank you Pamela [redacted] | CHC | Associate Director

November 1, To Whom It May Concern: We are responding to your recent correspondence dated November 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 concernsSince 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

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.

Due to the protection of the Health Insurance Portability and Accountability Act (HIPAA), I am unable to respond directly to you regarding these concernsSince your letter has provided a copy of the enrollee's correspondence and/or a description of the issue, we will respond directly to the enrolleeThank you, Brooklyn [redacted]

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me as long as I actually hear from them

I am rejecting this response because: I have not received a response from United Health Care nor a resolutionI do know they took another payment out of my bank accountPlease follow up with them asap and adviseThank You for your previous follow up with them

We have conducted a review of Mrs [redacted] 's referral history dating back to February Our records show that we received referral requests on February 8, 2016, February 12, 2016, February 17, 2016, February 22, and February 29, for various medical servicesEach of these referrals was approved and a letter sent to both Mrs [redacted] and the servicing provider within hours of receiving the requestThis response time does meet the TRICARE regulatory time requirementThe next referral requests were received on April 12, and April 13, These were requests for Mrs [redacted] to see an abdominal surgical specialist as stated by Mrs [redacted] in her complaintIn accordance with TRICARE Regulations, we must try to refer beneficiaries to TRICARE Authorized ProvidersIf 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 seeIn this case, Mrs [redacted] 's Primary Care Provider Henry [redacted] MD, requested an abdominal surgery specialist who is not TRICARE AuthorizedWe then searched for a TRICARE Authorized abdominal surgery specialist for the referralDuring this process we first search for that specialty within a mile radius of the beneficiaries homeIf none are found we expand the search to miles and again up to a maximum distance of miles from the beneficiaries homeAs stated by MrsAvvellan, an error was made initially and she was referred to a hand surgery specialistThis was corrected within business day as DrCharles [redacted] was locatedDr [redacted] is TRICARE Authorized and is just over miles from Mrs [redacted] 's homeDr [redacted] did request Dr [redacted] who is not a TRICARE Authorized providerOur medical staff within the referral department did conduct a full research to determine if we could refer Mrs [redacted] to this non-TRICARE providerThere are specific circumstances that will allow us to refer a beneficiary to a non-TRICARE providerThese circumstances include: No available TRICARE provider within radius (mile radius), with the specific service type and specialty requestedContinuity 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)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 concernAlso, Dr [redacted] is within the mile radius and has the ability to provider care to Mrs [redacted] in accordance with TRICARE standardsAs such, we are unable to make an exception and refer Mrs [redacted] to Dr [redacted] as requestedWe 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 systemHowever, we do find many other general and trauma surgery specialists as close as miles to Mrs [redacted] 's homeWe 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 specialistIf Dr [redacted] or Mrs [redacted] would like a TRICARE Authorized surgical specialist closer to her home, they can make such a requestMrs [redacted] can go onto the TRICARE.mil website to view all available surgeon's and submit such a requestWe understand Mrs [redacted] 's concerns and frustration over TRICARE network provider availabilityUnfortunately, we are unable to modify the approved referrals as they do meet TRICARE regulationsThank you

Initial Business Response / [redacted] (1000, 8, 2015/08/18) */ left detailed voice message for member today advising that the overpayment will apply to September and eft will not occur for September - left my call back information

Hello, Please review the attached response Sincerely, Travis [redacted] Regulatory Complaints Department

A written response was mailed to the member on 9-28-addressing his issues in his complaint The letter was mailed to the address for the member listed in the original Revdex.com complaint to Seattle, Washington - Yvonne S- UHC Consumer Affairs

Due to the protections of the Health Insurance Portability and Accountability Act (HIPAA), I am unable to respond directly to you regarding these concernsSince 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 meI can be reached during business hours at ###-###-#### Sincerely, Ishtor B.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 concernsSince 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 meI can be reached during business hours at ###-###-#### ext XXXXX Sincerely, Jodi O Consumer Affairs Advocate

Initial Business Response / [redacted] (1000, 5, 2015/12/10) */ December 10, 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 concernsSince 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 meI can be reached during business hours at 800-842-ext XXXXXXX Sincerely, [redacted] Consumer Affairs Advocate Initial Consumer Rebuttal / [redacted] (4200, 7, 2015/12/21) */ Have yet to receive correspondence from the businessPlease call (XXX) XXX-XXXX with information Final Business Response / [redacted] (4000, 16, 2016/01/12) */ January 12, Revdex.com Attn: [redacted] XXXXX RE: [redacted] : Dear MsKeate: 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 concernsSince 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 meI can be reached during business hours at 800-842-ext XXXXXXX Sincerely, [redacted] Consumer Affairs Advocate

Initial Business Response / [redacted] (1000, 5, 2015/07/29) */ To Whom It [redacted] Concern: We are responding to your recent correspondence dated July 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 concernsSince 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