Sharon – Missouri

Sharon’s Story

My husband had United Healthcare Medicare Supplement, with dental, in 2023. In May, he had 2 cavities filled. Our dentist’s office filed a claim with our private dental insurance but not with UHC. I contacted UHC (as an authorized representative) to find out how to file a reimbursement claim for our portion. I was told I could file online and was given specific instructions during a chat (I printed that transcript) but was prevented from completing the process by the site. The next advocate said they were not equipped to accept online claims. I needed to mail or fax it, including proof that the remaining balance was paid, which I did. I checked the dashboard for a few weeks and no claim was shown. I called multiple times to check that it had been received, always being chastised for not having the dentist submit the claim. One “advocate” asked for the PO Box where I had sent it. As I searched through my notes, she said that if I didn’t know it, she couldn’t help me and ended the call.

I mailed the claim a second time but again, no confirmation or indication on the dashboard. I’ve been given Issue #s, ID #s, promises of calls back, expedited processing, and escalation. I have attached the claim to emails and sent it directly to supervisors’ emails. On one occasion, I sent it and held on the line until the supervisor verified receipt but said it wasn’t in PDF format (another new requirement). She would see if it could be converted, but I never heard back.

In September 2023, I called and was told the usual “no claim found” excuse. On that same day, I received a letter from UHC saying that they couldn’t process the claim until I supplied the dental procedure code missing from the dentist’s statement, so clearly they had received the claim. I called and also sent the code in an email, only to be told it could not be accepted verbally or in an email. I sent the entire claim again, this time attached to an email I had been given by a supervisor. No confirmation of receipt. I called again and learned that the issue had been closed. On my next call, the “issue” was escalated to the supervisor’s supervisor, and the filing, including all requirements, was attached to the 2nd email. I was instructed to send it to: Attention SST Department. Again, no confirmation and no response to my emails. Somewhere along this process, I was told that I had to submit an Explanation of Benefits from Delta Insurance. I pointed out that the dentist’s itemized statement of account already showed that information. Shortly thereafter, I called and learned that this new “issue” had been closed.

I have spent hours – possibly days – submitting claims, making calls, chatting with advocates, emailing, etc., and chasing down this attempt to file a claim. In all, I have submitted the paperwork 9 times and I have never even been issued a claim number.

I notified UHC Civil Rights department (age discrimination) and the Better Business Bureau. I finally got a call from the Grievance Coordinator. She listened to my frustrations and said to expect a call from an advocate in a few days. She would follow-up by that Friday. In the meantime, UHC sent a form to the BBB, for me to complete to grant permission to share information. After 8 months, I thought I had finally made contact. The advocate call came later that week but, instead of being given a Claim Number, the advocate asked me one question: “Exactly what is it that you want?” That was what she had been told to find out.

In February 2024, I received a voicemail from the Grievance Coordinator and promptly returned the call. I left a message then and at least two more times. We then received a letter stating that we needed to file the claim again. It was followed a few days later by 2 identical mailings from UHC for my spouse to once again grant me the authority to speak on his behalf. This time, both my husband and I called and left voicemails which went unanswered.

Today, I received an email from the BBB stating that they determined that they could not help resolve my complaint. It was now closed and would show as being “Unresolved” on UHC’s profile for 36 months. I called the BBB to ask why and was told that UHC was no longer responding to their inquiries and that it was impossible to mediate with only one party engaging.

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