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The following is an expression of my right to Free Speech, protected under the First Amendment of the Constitution of The United States of America, It is the opinion and property of the author and is for entertainment purposes. As such it should not be considered actionable by any parties mentioned herein.

Policyholders, BEWARE of this tactic.

My daughter suffered a muscular injury due to sports. Went to see our General Practitioner, an M.D., who diagnosed the injury and ordered physical therapy. UHC authorized 8 PT sessions. We used 3 as most of the therapy involved out patient exercises. My daughter raegrivated the injury several weeks ago and we went back to the therapist, who wanted to start seeing her 2x / wk. UHC authorized only 2 visits ( our original authorization for 8 visits had 'timed out').

I called UHC for an explanation of their denial of benefits (each family member has 40 physical therapy visits per calender year as a basic benefit), and was told by a level one representative that UHC submits such claims to the AMERICAN CHIROPRACTIC ASSOCIATION for approval, and based on the ACA's assessment, UHC was authorizing two visits.

I asked the rep, point blank, what the relationship was between United Healthcare and the American Chiropractic Association and what was the nature of the contract between them. I was told by the UHC rep that there was no contract between UHC and the ACA.

The answer to my next question was stunning...

I asked, "... so, am I to understand that a professional association, that has never examined my daughter and has no contact with either me or our doctor and has no contract with United Healthcare, has the power to supersede a medical doctor's direct orders?"

The answer was"yes".

After speaking with UHC, I started doing my homework.

The American Chiropractic Association has enjoined in a class action against United Healthcare (www.erisaclaim.com/UHC_Complaint2.pdf) which alleges, among other things,

" In addition to its improper recoupment activities, United, through its wholly

owned subsidiary OptumHealth, Inc. ("Optum"), also engaged in improper actions, including

denials of benefits, by application of flawed, manipulated and undisclosed policies designed to

discourage and limit the provision of health care services, as described herein. In so doing,

United has similarly violated ERISA. "

It seems odd that the ACA would take it upon itself to be an arbitrator, and take on the liability of superseding a Medical Doctor's orders when it is:

A) Suing UHC for denial of benefits contrary to care plans, and ...

B)According to the ACA's own Policy Papers ( www.acatoday.org/level2_css.cfm?T1ID=10&T2ID=117):

DIAGNOSIS - ACC STATEMENT

Resolved, that the House of Delegates endorse the ACC statement on Diagnosis:

"A diagnosis is an expert opinion identifying the nature and cause of a patient's concern or complaint, and/or abnormal finding(s). It is essential to the ongoing process of reasoning used by the doctor of chiropractic in cooperation with the patient to direct, manage, and optimize the patient's health and well being.

The process of arriving at a diagnosis by a doctor of chiropractic includes: obtaining pertinent patient history; conducting physical, neurological, orthopedic, and other appropriate examination procedures; ordering and interpreting specialized diagnostic imaging and /or laboratory tests as indicated by symptoms and/or clinical findings; and performing postural and functional biomechanical analysis to determine the presence of articular dysfunction and/or subluxation."

If this is the Policy Position of the ACA, why would the ACA presume to pass judgment over another medical professional without taking the steps required of their own members?

IS this just a tactic being used by United Healthcare, in effect throwing the ACA 'under the bus' as an excuse to deny a basic benefit of the policy already paid for by we, the policy holders?

I am digging into this issue and ask any who read this and may have a similar situation to post on this thread.

Sincerely,

Mike

Tucson, Az.

Location: Tucson, Arizona

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Guest

Interesting. I am fighting with Aetna to get physical therapy after ACL reconstruction surgery.

I have 60 visits a year, but Aetna changed to a policy of requiring precertification. On the day of my surgery. I have plenty of visits available, but they have only precertified 12, then 5, then 3. I haven't used the 3 yet and got a letter saying I hadn't made enough progress, so now I have none.

This is all Optum. Contracted by Aetna to handle claims. Interesting that Optum is a subsidiary of United Healthcare. They all seem to be in bed together.

Just scrolled up. 2011 for you. 2016 for me. Will look at the comments.

It is just pitiful. I will be working for single payer. The CEO of Aetna makes 13-15 MILLION a year and has a 135 MILLION dollar golden parachute.

So denying me the paltry reimbursement on my physical therapy multiplied many times over by all the rest of you out there is simply buying this man more trinkets. Sick.

Guest

AS previously posted United HealthCare (UHC)uses ACN for the administration of its chiropractic, P.T & O.T. The American Chiropractic Network or ACN is not a chiropractic association. It is wholly owned by a subsidiary of UHC and its sole purpose is to deny claims or restrict care, without violation of UHC's ERISA obligations to its subscribers and possible suits against them.

Guest

I had regular therapy denied ordered by an orthopedic after a very serious injury. I went about 4 wks and they cut it off when I still have a long way to go. It's not chiro care being ordered.

Guest

Just to help clarify things for you, the American Chiropractic Association has no relationship with United Health Care. As a practicing chiropractor who has to approve benefits through the same system as the PT, the organization the rep was referring to was American Chiropractic Network, which was re-named as Optum Health. They are owned by United Health Care and have to approve all chiropractic and/or physical therapy for the insured.

Guest

Interesting to see that I'm not the only one being subjected to Oxford/United's illegal, Hitlerian tactics -- such that they blatantly violate state and federal statutes prohibiting denial of benefit coverage to people with chronic, preexisting conditions. Instead, Oxford/United believes it is powerful enough to arbitrarily discriminate against, and terminate such benefit coverage on members they wish to drop.

Cases in point:

Patanol eye drops - a necessary non-steroid treatment I must regularly take for an eye condition in order to keep wearing contact lenses. An Oxford "pharmacy representative" sent me a letter 2 months into the plan, after Oxford saw I was using this Rx drug, to say it would no longer be covered - and would now require the filing of an appeal by myself or my eye doctor! However, Oxford's sales rep had told me in February before I joined the plan that Patanol was a covered drug. So Oxford/United's game was to arbitrarily stop covering this drug when they saw it was needed for a chronic, preexisting condition รขโ‚ฌโ€œ in an intimidation effort to encourage me to leave the plan.

Oxford/United Healthcare's failure to honor the $10 generic drug discount charge on generic erythromycin, forcing me to pay the name brand price (which was needed for a chronic infection) - in violation of plan terms.

Failure by Oxford/United Healthcare to notify my ear-nose-throat/otolaryngology specialist's office of any word on a pending authorization request for urgently needed surgery for a preexisting condition. Although Oxford backdated a dummy "approval" letter for the surgery, it was never relayed to the specialist, thus preventing me from having the surgery the month for which the bogus approval was dated - which is tantamount to no surgery approval at all.

I'm interested in hearing other people's stories on similar illicit conduct by this insurance monopoly. Please keep sharing - and fighting their wrongdoing!!

Guest

My boyfriend is a surgically trained podiatrist. He is board certified in foot and ankle surgery for the last 20+ years.

United no longer covers podiatric services. NONE.

They were already difficult to work with in submitting claims, and now they are denying podiatric services. It is a real shame.

Guest

I am having the same type of trouble only on a dental claim. My next step is to call the Insurance Commissioner of my state and file a claim.

This is the most horrible insurance I have ever had. They do everything they can think of to get out of paying any claims.

Guest

The following is an expression of my right to Free Speech, protected under the First Amendment of the Constitution of The United States of America, It is the opinion and property of the author and is for entertainment purposes. As such it should not be considered actionable by any parties mentioned herein.

Boy, United Healthcare hoodwinked me good!

The calls to UHC referred to in the above post were on Fri. April 29th Chrissie, the UHC phone rep. was the person who told me the AMA was their '3rd party administrator'. It is actually the American Chiropractic network (ACM), which is actually Optum Cervical Network, a department of Optum health, the WHOLLY OWNED SUBSIDIARY OF UNITED HEALTHCARE and is used by UHC to administrate claims.

I spoke with a manager at the AMA, and this is not the first time they have heard of this. The AMA has enjoined in the suit against UHC mentioned in the previous post.

This information is the result of three phone conversations with UHC personnel

1) Chrisse: 800 number phone rep., who gave me the misinformation about the AMA.

2) Crystal: 800 number phone rep. who gave me the misinformation that the 'third party administrator' was the American Chiropractic Network.

3) Lance (?): a 'Rapid Response Expert' who refused my request for a review of the claim denial, as provided for under the federal 'Employee Retirement Income Security Act' ( ERISA). This 'expert' also referred me to call Optum Health and speak to the 'Support Clinician' Mark Tate PT, the person who denied the claim.

One issue with that; Optum Support Clinicians will not speak to policyholders!

I was also told 'all the supervisors just went into a meeting' and was promised a supervisor's callback that never materialized.

The following is a synopsis of this issue so far:

04/29/11- I spoke with four UHC reps. Outcomes are listed above

05/04/11- I called Optum Cervical Network ( or the AMC, or the ACA, depending on which UHC phone rep. ya' get???). I was told by Ralynn, an 800 number phone rep. that I could not, in fact speak to Mark Tate PT, at which time i asked to be transferred to a manager. The rep. refused, attempted to convince me to terminate the call, and terminated the call at 18min.+, after assuring ma a supervisor callback 'as soon as possible', and 'policy allows for 24 to 48 hours for a supervisor callback'. FOR THE SECOND TIME, THE SUPERVISOR CALLBACK NEVER MATERIALIZED.

05/06/11- I took my daughter back to our pediatrician. the doctor reconfirmed the diagnosis, confirmed the re injury, and confirmed the need for continued physical therapy, completely supporting the physical therapist's order to continue therapy. The doctor then wrote a 'Letter of Medical Necessity' at my request.

Today, Monday 05/09/11- I, with the Clinical Manager of the physical therapy firm, attempted to reach a relevant party at Optum cervical Network (Optum Cervical Health?). When we finally where going to be transfered to the Clinical Support Department at Optum Health, the Clinic Manager got a voice prompt that told him the number dialed was invalid and to redial the 800 number.

i redialed and the rep. answering refused to talk to anyone but PT staff. the manager was helping a patient, so an office staffer took the call. A new stone wall popped up. the rep. claimed only the Support clinician ( Mark Tate PT) from Optum Health would talk to ONLY the therapist actually working on our daughter....apparently the CLINIC MANAGER, A LICENSED PHYSICAL THERAPIST AND IN CHARGE OF THE ENTIRE STAFF wasen't good enough for Mark Tate PT.

Since this morning, I have been on the phone with UHC, mostly on hold (2Hrs., 11min for a supervisor). I am currently on hold as UHC managers try to reach a relevant authority at Optum. this would be funny if it wasn't true.

I will post the outcome of this call. I have theLetter of Medical Necessity waiting to be faxed by our provider to a relevant authority at Optum. There IS someone at UHC with the juice to pick up the phone and tell Optum to act on the letter today...

Guest
reply icon Replying to comment of Guest-284034

Just found this post. It's 2013 now and Optum is still doing the same thing.

They've cut my therapy off at half of what my plan allows for. I've spoken to 7 UHC and 2 Optum folks so far, which has taken somewhere between 4-6 hours. I have the name of the person who makes the decisions (Tracy Kay), but he has a rule against speaking to UHC members.

Everyone but the call center folks are pretty well insulated. It's funny, Optum's website has pictures of healthy looking people climbing mountains and talks about "relationship" and "joint decision making" but the reality is they aren't allowing me to take part in the decision making process and have no interest in relationship with me.

Guest
reply icon Replying to comment of Guest-284034

It's May 2013 and I am getting the same run around with these clowns, how is it they can do this and waste our time and taking money for coverage that is not even covered. It's a scam that the government should not be allowing.

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