AARP United Healthcare Medicare Advantage Plans - A Coordination of Benefits Nightmare

[MichaelW804764]

To: United Healthcare, Optum, the South Carolina Department of Insurance, AARP, BBB, Current & Prospective Future Enrollees in AARP UHC Medicare Advantage Plans

I am writing to make the entities above aware of the experience that my wife and I have had with United Healthcare (UHC) and Optum over the past 3 ½ years relative to their Medicare Advantage Plans. To say the least, it has been a VERY frustrating and disappointing experience.  

When I retired in January 2021, my wife and I enrolled in one of the AARP United Healthcare Medicare Advantage Plans offered in South Carolina, where we live. I retired as an executive with over 40 years in the managed healthcare industry, so I am very familiar with Medicare Advantage plans and how they are supposed to work. (The company from which I retired is not currently licensed in the state of South Carolina). My prior Group Plan coverage terminated on January 31, 2021.

As I have said over and over again to representatives from UHC and Optum, THERE HAS NEVER BEEN “OTHER COVERAGE” for my wife and I since we started receiving services covered by the United plan. My prior insurance carrier even provided written documentation to UHC in 2021 clearly stating that my group coverage terminated on January 31, 2021.

Yet, over the past 3 ½ years, UHC has continued to deny our claims “due to other coverage”. On numerous occasions, we were denied coverage at our local pharmacy counter (with a line of people standing behind us) because “your insurance company says you have other coverage that should pay first”. On occasion, we’ve also been told in a physician’s office, that “the doctor will see you and we will bill your insurance, but be aware that they say you have other coverage and they will not pay the claim because your other coverage must pay first; so YOU will be accountable for payment of the full amount of charges”. One provider (an Urgent Care Center), after months of dealing with UHC, told me that, as a “favor” to my wife and I, they were going to write off the balance because it was not worth their time and effort to continue to get UHC to pay. In addition, in several cases (two in the last two weeks), providers have called, texted and emailed us demanding payment for services (going back to 2021) that UHC says they shouldn’t have paid because we had other coverage and UHC is demanding return of the claims paid to the provider.

I have spent hundreds of hours in dozens of phone calls with United Healthcare and Optum to try and get this issue resolved. Each call ends with them assuring me that the problem has been resolved and that there should be no further instances of “other coverage” denials, yet here we are 3 ½ years later and the problem is still not resolved. I was so frustrated in 2021, that I wrote to Mr. Tim Noel, the CEO of UHC’s Medicare & Retirement business to ask for help. (I can provide a copy of the letter, if necessary. Within a week, three different individuals identified as “Directors” called to assure me that the problem would be resolved post-haste. And the problem is STILL not resolved.

It seems to me that there are only three possible explanations for the fact that this problem has not yet been resolved:

• A lack of true accountability / ownership for issue / problem resolution within United Healthcare
• Total incompetence on the part of UHC
• Deliberate attempts to delay or forgo the timely and accurate payment of claims

So, to the regulatory bodies above, I ask:

I know that you are charged with monitoring the performance of companies like UHC and Optum. Are we the only UHC Medicare Advantage enrollees experiencing these types of issues? And PLEASE do not tell me to fill out a Grievance form for each date of service and claim denied. You have access to our records. Look at them! Pull the UHC call logs for the past 3 ½ years under our membership numbers and listen to them. Add up the total number of hours I’ve spent trying to get this issue resolved, then tell me if we’re being unreasonable.

To AARP:

Your name is on these plans. Retirees trust your recommendations. Do you monitor your recommendations after the initial endorsement to ensure that the companies still deserve it?

To the BBB:

I’m just putting this on your radar.

To current AARP UHC Medicare Advantage enrollees:

I’d be interested in hearing about your experiences. Hopefully, they’re much better than ours.

To prospective future AARP UHC Medicare Advantage enrollees:

Do your homework. Solicit feedback from current and past enrollees in these plans before you enroll. Hearing the actual experience of enrollees may help you avoid much frustration, disappointment and time on the phone.

At this point, short of litigation, we don’t know where else to turn. And this experience is now beginning the affect our health – the frustration and stress are taking a toll, with no end in sight.

Michael Wathen

Mike.wathen@comcast.net

[GailL1]

@MichaelW804764 

Sounds like a nightmare -  a couple of questions.

You and your wife have separate coverage but the same plan ? Right?

 Is it happening to each of you in your respective Advantage plan?

Is this AARP UHC Medicare Advantage plan a MAPD?  Meaning that your prescription drug plan is included in the overall Medicare Advantage plan?  Or is it a free-standing Part D plan ?  There are a few of those still around where you have a MA plan + a PDP plan but most are now MAPD plans nowadays.

You do know that you have the right to change yourMedicare Advantage plan every year during opening enrollment in the fall.  Might be time to consider this especially if you can find one that suits your needs and your wife can also pick one that suits her needs.

Have you each tried setting up a Medicare.gov account and check to see what plans are showing on your file.  It will show your enrollment dates for Medicare Part A & Part B and I believe that it shows how each of you are getting your benefits and the name of the company that each of you have your MAPD coverage and any other insurance - I think.  (I have original or traditional Medicare with an outside Part D and mine shows - so I am assuming yours will too. This might show you if the problem is showing on your Medicare number account.

Did you two sign up for Medicare (Part A or Medicare Part A & B) in 2021 or earlier?  IOW, was there anytime when you did have Medicare AND Employer Coverage that worked together in some coordination method?

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