United Healthcare

I have had a Medicare Advantage plan from United Healthcare (UHC) for several years. In the past, I have had no problems. This year is quite different. During the annual renewal period, I received a telephone call to renew my policy. The agent said that there was a new plan (2023) with all the coverage of my current (2022) plan plus dental coverage. Based on this representations (which turn out to be false), I signed up for this new plan for 2023. In March, I found out that the person selling the plan had lied to me. My 2022 plan had coverage for prescription eyeglasses. The 2023 plan did not have this coverage. When he said that the 2023 plan had all the coverage of my 2022 plan, he lied. Making a false statement to induce the purchase of something is fraud. I found that I had be defrauded when I called UHC about denial of coverage. They confirmed that the 2023 plan did not have prescription eyeglass coverage. In May, I received a bill for a medical procedure. I had had the same procedure from the same doctor in 2021 (under the old plan), and I had no co-pay. When I had the same procedure in 2023 (under the new plan), I had a significant co-pay. Around May 15, I called UHC to discuss these issues. On the call: 1. I asked to be sent copies of my plan documents for 2021, 2022, and 2023 so that I could confirm whether or not the plans offered the promised same coverage or, alternatively, whether I had been defrauded. I was promised that this would be mailed to me. 2. I asked why I was charged a significant copay for the 2023 procedure when there was no co-pay for the 2021 procedure. I returned from vacation on June 15. The copies of plan documents had not arrived, and I had received no communications about the co-pay for the procedure. On June 19, I called UHC. I explained the prior conversations, and I asked the "advocate" to look up the notes from them. 1. I was told that the plan documents had been mailed to me week ago. I repeated that they had never been received. We confirmed that UHC had my correct mailing address. The advocate did not offer to resend the documents. 2. I asked the advocate to look up the noted from my May call to see if the co-pay issue had been documents. I was told that it had not been documented. 3. I asked the advocated to look up the issue about lack of coverage for eyeglasses was document. I was told that it had not been documented. 4. The advocate did not understand my displeasure that my prior call had led to no progress. I asked to speak to a supervisor. I was connected to a supervisor who identified himself only as Kenneth. I explalined the issues to Kenneth. He said that he would look into them and call me back within one to two hours. That was on May 19. Kenneth never called me. On May 21, I called UHC again. I asked the first advocate to connect me to Kenneth. It took a while, but she said that he had contacted Kenneth, he was on a call, but he would call me back right after he got off that call. That would about five hours ago. Kenneth never called back. When Kenneth hadn't called back in over two hours, I called again. This time I spoke to an advocate who said that no supervisors were available. She put me on hold. After a very long time on hold, my call was returned to the inbound call queue. The advocate had simply blown me off. The new advocate was able to transfer my call to a new supervisor Darby. Darby was helpful. 1. She promised to send me the policy documents for 2021, 2022, and 2023 which I had mysteriously never received. 2. I explained that I had been lied to in the sale of the 2023 policy. She told me that the agent who sold me the policy was an independent agent -- not a UHC employee. 3. After a great deal of insistence, Darby provided the selling agent's ID: 634****. Darby didn't know if this ID was issued by the State of Texas or by UHC. When I asked for the name of the agent, she said it was not readily available. After much insistence on my behalf, she said the agent was Nathan Edmunds. She couldn't provide any contact information. I told he I wanted it to be able to sue Edmunds for fraud. 4. Darby investigated the co-pay issue. Apparently, UHC doesn't employ the man who sold me my policy, they also do not process the claims. That is outsourced to a company called Wellmed. (I wonder what UHC actually *does* to earn billions of dollars a year!) Darby couldn't understand why I had a co-pay in 2023 when I had no co-pay in 2021 for the same procedure performed by the same doctor who charged about $10 less in 2023. She called Wellmed, and she reported to me that Wellmed provided some nonsensical explanation. The claim will be resubmitted to Wellmed, and I expect I'll have no co-pay. I probably spent 8 hours on the telephone to UHC regarding these issues. Their advocates are poorly trained. They don't understand basic questions. They put you on hold until your call is transferred to someone else, and you have to start over from scratch. When you report that you haven't received documents which their records showed to have been mailed a month ago, they don't have the common sense to say that they will be resent. Supervisor Kenneth still has not returned my call. He clearly is unreliable and untrustworthy and doesn't give a damn about the service level commitments he makes. UHC uses third parties to sell its policies and will not provide an insured party the make of the independent agent who sold the policy. So, in my case, UHC is protecting the man who defrauded me. Is that the sort of company you would want to do business with? I'll be switching insurers for my Medicare Advantage policy for 2024. I prefer to deal with companies which employ well-trained staff, don't put me on hold for 30 minutes, and don't cover up third party vendors who commit fraud.