| Reviewers Male / Female |
Recommend Yes / No |
Number of Reviews | Coverage | Claims | Customer Service | Cost | Total Average Rating |
| 1 / 0 | 0 / 1 | 1 | 5.00 | 5.00 | 4.00 | 3.00 | 4.25 |
| Date Submitted: | November 1, 2007 |
| Insurance Provider: | United Health Care in California |
| Coverage: | 5 out of 10 |
| Claims: | 5 out of 10 |
| Customer Service: | 4 out of 10 |
| Cost: | 3 out of 10 |
| Recommend: | No |
| Review: | Headaches, frustration, with some silver linings. I pay a lot to be in their Definity Gold plan (the best my company offers) which requires that you use doctors, Labs, and hospitals in their preferred provider list or you pay an additional 20% out of pocket and anything that is above their payment for in network providers. They had a reasonable list of doctors in their preferred list. Since they were purchased by Pacific Care they are reducing their payments for service and we are getting letters from our doctors that they can no longer accept their coverage. If you go to a doctor who is in their list or was in their list their list last time you went to the doctor there is no guarantee that they would be dropped from the list while you’re driving to your appointment. My Family has been bit twice this year by that. If your lab work isn’t sent to a lab on their list you pay the penalty. You can get an out of network exception supposedly if they have no provider in network within 30 miles of you. But, if they have a provider on their list even if they don’t exist or don’t do what it is you need you’re screwed. I wasted a day and a half on the phone with them trying to get this done and they lost all five (5) requests that they entered in their system. If the condition is serious or an emergency it will not get done and you’ll be the one paying. I am trying to get an out of network exception for something that is not immediately life threatening. It’s taken three weeks and they agreed to pay the doctor (whatever that means) but they lost the part about the device the doctor is fitting to me and we are resubmitting. They do pay about 80% of the time without all the hassles. But they are slow. So if your time has no value at all. This might not be a problem. The silver lining is. They do have nurses you can call any time of the day or night for advise and if you have major surgery a nurse is assigned to you who reviews what the doctor has done and is planning and our nurse actually suggested requesting Physical Therapy., and has given good suggestions on fighting the bureaucracy of trying to get a bill paid. Comments [ 0 ] |
| Submitted by: | Roper 50 year-old :: Male Reviewer :: Orange County |
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