jillian vs. united healthcare :: the happy ending

My employer changed health insurance providers on May 1, from Blue Cross to United Healthcare. This meant that my obstetrician, whom I adore & am very thankful to have, was no longer covered. But when I mentioned it in a meeting, the insurance broker assured me that due to my pregnancy status at time of changeover (8 months), they would issue “transition of care” and my doctor would be covered and paid for. Sounds good, right?

I should have known there would be a catch. First of all, the forms were vague in their nature, which frustrated the admins at my doctor’s office. Said forms didn’t even include a place to add my member ID and other info. I had to remember to write those details on the forms at the bottom, or else they could get lost in the system.

Second, the forms had to be received by UHC within 30 days, or I wouldn’t be eligible for the transition of care coverage. So I had them completed by my doctor’s office on April 24th, and then faxed them to United Healthcare on May 6th.

That’s when my three week battle started to get United to admit they (a) had the forms and (b) were covering my doctor. Keep in mind,for each of the six calls I made to UHC, it took between 30 and 60 minutes of my workday. And, after the first few days, I was too upset to work efficiently for a while afterwards, out of fear that UHC would just keep jerking me around until I gave up and paid the $4K for the delivery out of pocket. The thought of spending my summer chasing them to reimburse me for the obstetrician they promised to pay for was too much for me to handle.

I think the moral of this story is that we don’t necessarily need universal healthcare as much as we need the existing health insurance companies to accept responsibility and be held accountable for their promises. If I wasn’t the type of girl to call obsessively for a month, United might have been able to keep “not receiving” the forms, and weasel out of coverage using that 30 day clause. They certainly seem to try to get out of paying for things using this same labrythine phone system & “loss of paperwork” excuse before: Consumerist.com has a great story of how they tried not to pay for a covered checkup for 10 months. They are also under investigation for fraud in NY state. This system tries to just wear people down until they give up and pay the doctor’s bills, rather than let said bills go to collections, and then good luck getting reimbursed.

I got a happy ending out of this. Theoretically, everything was eventually processed, and my out-of-network obstetrician is now covered & will be paid for. But it took a lot of time and hassle to get there. Here’s the whole timeline:

5/7 – Faxed forms the 1st time to phone number I was given by customer service.

5/9 – Faxed forms the 2nd time to same number after being told that the forms were not received

5/12 – Was told that the forms were STILL not in the system, and that the “outsourced center” that received the forms “might not have processed them”. In fact, they “might have lost them”, and I should wait “a couple more days” to see if they turned up. I refaxed the forms for good measure.

5/16 – Called in again. Still no forms. Was transferred to Rapid Resolution department for extreme customer service resolutions. They told me to fax the same forms to the Rapid Resolution number, with a reference number.

5/19 – Confirmed that the forms were received and scanned in, but would take up to 10 business days to be reviewed & approved

5/27 – Called to follow up on the approval, and was told that the forms had gone to the wrong department. I was sent to Rapid Resolution, who gave me a THIRD fax number. for a whole new department (Continuity of Care dept) and told me to mark the cover letter as URGENT.

5/28 – In a call between Customer Service and Continuity of Care, neither department is able to find the forms, and neither can determine which department is responsible. Rapid Resolution was brought in, and I repeated the entire above timeline. They confirmed that they HAVE THE FORMS, and have since 5/19, and the representative is just now submitting them to the correct department for approval as an “escalated issue”. And that correct department isn’t the Continuity of Care they told me to send the forms to the day before.

5/28 – I complain to our HR, who gets a client services manager involved. She requests that I re-send the forms to her directly, because they aren’t in the system anywhere else that she can see. I fax them. And I send a PDF scan via email.

5/28 – I overnight mail them to the address that corresponds to the original fax number I sent to in the first place, so that I have a paper trail confirming that I sent the forms within 30 days, because they don’t seem to be staying in the system

5/29 – The client services manager confirms that she has the forms and has sent them for processing to the correct people.

5/29 – I get a call from an EXTREMELY nice lady in Continuity of Care, which was the department I sent the forms to on 5/27. This is the department that wasn’t supposed to get the forms, according to the 5/28 call. But this woman saw my cover letter, explaining that I was 37 weeks pregnant, and was so concerned that she called me to try to help. She got on the phone with customer service with me trying to fix it. I knew the forms were going through the client services manager that my HR had put me in touch with, but figured the more channels those forms went through, the better.

6/2 – 30 days is up. I can only hope that the forms are being processed somewhere and I will get the approval I need for UHC to pay for my doctor.

6/2 – I get a call from a rep in Transition of Care, who is approving my documents. Somehow, those forms got to where they needed to be, and were immediately approved. I confirm – this means that all the appointments I’ve had since 5/1, and everything I will need through my post-partum care, will be covered, and I will get that in writing. I immediately write thank you emails to HR and to the client services manager letting them know how ecstatic I am to have this resolved.

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