Tuesday, May 28, 2013

United Healthcare? Not "Caring" so Much...

I am freaking LIVID.

My allergy shots are suspended until further notice. United Healthcare chose my account to audit with the allergist and their auditing company has determined that United Healthcare shouldn't pay for the vials of serum I receive in my shots because none of my appointments in the records my doctor's office sent over correspond with the 4/1/13 date of service on the claim for the serum.

In other words, the auditor doesn't understand that "date of service" in this case corresponds to the formulation of the serum for my shots, not a patient appointment.

I am in touch with my local insurance folks' office and they're in contact with their UHC person, so we'll see how this goes from there.  Thus far UHC has told my insurance brokerage that the claim was denied because "we didn't get the records we requested in a timely manner" while at the same time they're telling the doctor's office those same records (that they supposedly didn't receive) don't correspond with a patient visit when the charge wasn't for a patient visit in the first place.

The mind boggles.

Weirdly, UHC has no problem paying for the injections themselves.  They're also fine paying for my visits to receive them.  They just don't want to pay for the shot contents

I'm going to go off and beat my head against a wall while I try to get this situation resolved.  And people don't think there's a healthcare crisis in this country?  Really?

United Healthcare, my office pays in excess of... well, an amount I won't go into here.  But suffice it to say, they pay a HUGE amount of money to insure us all.  They did so even prior to the ACA.  Stop playing games with my health.

Earlier this allergy season I was in absolute misery.  From December through early January I was literally near scratching my eyes out, despite the use of Zyrtec, Benadryl, Zaditor (OTC eyedrops)... nothing worked.  Patanol (prescription antihistime eye drops) caused a reaction whereby the itchiness of my eyes was exacerbated.  The only relief I got was from Alrex, a lovely prescription steroid eye drop.

Problem there?  Extended use causes glaucoma (and my genetics already swing me that way) and can drive up the age at which those prone to cataracts will develop them by 10 years.

Yes, I'm also genetically predisposed to developing cataracts, so lovely.  Sigh.

I went to an allergist, and considering my symptoms, the fact that they've become impossible to control even with standard prescription intervention, my minimum 7-month allergy season, and the fact that I reacted to All The Things on the allergy test, it was determined that allergy shots (immunotherapy) were my best bet.

Now I can't even get that, because some auditor is too thick to understand that "date of service" need not coincide with a patient visit.

This is flatly ridiculous.  I'm so angry and upset I'm literally shaking.

Thanks, United Healthcare.  Thanks for condemning me to an even worse allergy season this upcoming winter.  I'll think of you when I'm sitting on my hands trying not to rip my eyes from my skull.



Norma said...

Bureaucracy at its finest.

Total BS, Amanda. I hope there's one intelligent person who can figure this out for you.

Brent said...

I go through the same thing with my insurance company. Every freakin' time the kids or I have to go to the doctor it's the same crap. It's only going to get worse, IMO.

Amanda said...

Thanks Norma. Me too.

And I know, honey, I know... it's easier for me when you're dealing with it though :P

I'm just so angry about this. First they claim they're denying the claim because the shots "aren't medically necessary". Then they claim they're denying it because "the doctor's office didn't get us documentation in the time we allotted". NOW they're saying it's due to this ridiculous "date of service doesn't align with the records we were sent".

Yes, those same records I was told earlier today you... didn't receive?

They can't even keep their stories straight, and I think that's what pisses me off the most. This is just such a flagrant attempt to avoid having to cover my claim, and meanwhile I'm already back on the stupid steroid eye drops.

I need to start learning Braille. Pretty sure even if health insurance covers that they'll find a way to deny the claim...

Dr. J said...

Do the shots help you?

Amanda said...

Very much so. I'd managed to get off the steroid eye drops and was only needing to take my Zyrtec and use the occasional drop of Zaditor when my eyes were itchy. Now I'm back on Alrex 4x/day and my eyes are still not as good as they were prior to the shots being terminated (due to UHC's denial).

If they didn't help, believe me I wouldn't be getting them. My allergist is the next town over, so dedicating two hours per week just to get jabbed in the arm 4x each trip isn't exactly hobby material ;)

But dedicating two hours per week to feel worlds better... I can do that. Easy.

It's a moot point at the moment, though, because I can't get them until the appeal works its way through United Healthcare's channels and we see where everything falls out. My insurance broker and my doctor's office seem to feel pretty confident they'll get it covered, and that United Healthcare is just wanting to avoid the expense, but in the meantime my wellbeing is significantly less without the shots.

Not much I can do about it for now except breathe. Through my mouth, though. My nose is stopped back up too...