r/HealthInsurance • u/One_Combination5776 • Feb 07 '25

Claims/Providers UnitedHealthcare Deletes Incriminating Chat

I had a certain medical appointment. I used the chat function about a month ago to verify that it was covered and what my out of pocket total would be. I provided all information such as facility name, address, Tax ID, and NPI number. They explicitly said that it is in network, is covered, and what the total is.

Fast forward a month and it was NOT covered. I knew someone somewhere told me it was but forgot who I talked to. I then scrolled up and saw it was in this chat that I verified the confirmation. I took pictures of the chat on my phone and called them out, telling them they told me in the chat it’s covered. I will have to have the medical office re-submit to insurance under a different code or something.

I then went back to look at those messages where they claimed to cover it. They were GONE. Just 30 minutes later. They weren’t the oldest or newest messages. Right in the middle. Messages before and after were still there.

I then called them out saying those messages are gone and I have screenshots proving they said the appointment is covered. And guess what, they are back an hour later.

I checked through the chat over and over to make sure my eyes were not deceiving me and that I wasn’t crazy. I also had my wife verify too.

I truly believed they made that section of the chat not visible to me, so I wouldn’t have proof of them saying it’s covered. Once I called them out and said I have proof, they brought it back. The coincidence is too large.

Has this happened to anyone else? Is this something they can do?

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81

u/msp_ryno Feb 07 '25

NOTHING IS EVER A GUARANTEE OF PAYMENT. They will tell you that expressly.

40

u/One_Combination5776 Feb 07 '25

That’s fine. My question is why did just that snippet of the conversation go missing. Not the stuff before or after. Just that one part.

18

u/Coffeejive Feb 07 '25

Guess they were deleting your paper trail...like mine. My idiots fired the asst and have said not a thing re my treatment. It is best to move on. The drama is debilitating

3

u/Savingskitty Feb 08 '25

We didn’t have chats when I worked for them, but knowing the way the email systems worked back in the day, it is possible they actually cut and pasted into notes instead of copy and pasted.

We had to make a contact record in our call system for each email, so you copied and pasted anything that was referenced into the call system notes.

We literally made the emails using macros in Word.

Not sure how old their current chat set up is, but I wouldn’t be surprised if it was something absolutely brain dead like that.

14

u/One_Combination5776 Feb 07 '25

Separate question. What if you need an extremely expensive surgery. Can you ever be 100% guaranteed that something is covered? This event wasn’t that costly but what if you expect a $100k surgery to be covered and then it isn’t?

41

u/Knitwitty66 Feb 07 '25

That's the fun part of American medicine and insurance. You get an operation to fix a painful problem, and they tell you it's covered, but you don't find out until you're home from the hospital that Oopsy, it's actually not covered. And you've signed paperwork at the hospital agreeing to pay what the insurance doesn't.

There's nothing else we buy that this is allowed. I have put off tests that I need to have done because I have UH and I'm afraid they're going to pull this same garbage.

13

u/skydreamer303 Feb 08 '25

This. My insurance swore up down and sideways they would pay for my jaw surgery. They paid for the one night hospital stay...I got stuck with 30k surgeon fees 🥲

2

u/YogurtclosetOpen3567 Feb 08 '25

Did you appeal? That sounds liken a strange denial

3

u/skydreamer303 Feb 08 '25

Yes. Multiple times. Got fucked. Its pretty common for this type of surgery. They couldnt explain to me why they would cover the hospital stay for said surgery but not the surgery itself.

1

u/YogurtclosetOpen3567 Feb 08 '25

Did you look at the EOB, was it because of our of network or medical nessecity because in some cases you have the right to an independent reviewer

1

u/skydreamer303 Feb 08 '25

Yes, every jaw surgeron is OOO for most insurances. At the time I had UHC and filed for gap exception which is the only reason they even paid for the hospital bill. They did not cover a single surgeon In network.

1

u/YogurtclosetOpen3567 Feb 08 '25

Wait and then what did you do when they denied it? Once you exhausted the appeals

1

u/skydreamer303 Feb 08 '25

I ran out of appeals then had to use a credit card to pay for it? it is 0% APR at least

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0

u/Savingskitty Feb 08 '25

That is insane.

19

u/Ok_Appointment_8166 Feb 07 '25

They'll call your surgeon in the middle of the operation to cancel it. https://www.newsweek.com/doctor-says-unitedhealthcare-stopped-cancer-surgery-ask-if-necessary-2012069

5

u/w_v Feb 08 '25

And they’ve now hired a defamation team to sue her because they have proof that she made the whole story up. Will be interesting to see how that pans out in a court of law.

2

u/The_Great_Skeeve Feb 08 '25

What proof?

3

u/w_v Feb 08 '25

They’ll show it in court apparently! Let’s keep an eye out for it!

2

u/Flat-Series5764 Feb 09 '25

I work in health insurance and to answer this question bluntly, no (mostly). Typically, at least with the plans I work with, surgeries require a prior authorization. There’s always a chance those could deny if the procedure isn’t deemed “medically necessary”, but this is what appeals are for. Get all the medical records you can and prove that what you’re needing IS medically necessary. Now, if you’re getting something extremely common like a screening colonoscopy (assuming you meet USPSTF guidelines and assuming the provider bills the claim as prev/screening) then you can pretty much guarantee that will be covered at 100%. However there’s also a lot of reasons a claim could deny, maybe when the provider called in the prior auth they gave the insurance a different diagnosis than what they ended up billing on the claim? Maybe you need to update coordination of benefits? I know insurance is scummy I do, but there’s actually a lot of behind the scenes stuff that can go wrong that members do not know about. Sometimes providers try to shift the blame on situations because it’s easy to blame the insurance. Again, I know insurance is scummy and it sounds like your situation specifically is extra scummy given they’re deleting the specific chat, but as someone in the health insurance field there is scummyness on both sides of the fence

-5

u/[deleted] Feb 08 '25 edited Feb 08 '25

That would be what pre-authorization is for… you don’t seem well educated on this topic.

It seems as though you misrepresented the nature of the conversation, you admit that they didn’t guarantee it would be covered, because that’s by default a boiler plate policy.

Good luck in life with this mentality.

No one is wasting time deleting chats at a $100 billion+ market cap company over such a pittance of money.

Basic logic. It was denied, you accept it was denied, you admit you should have known it wasn’t a guarantee. What would the result of having the message be? You still being denied.

Grow up.

If the messages were deleted it’s because of a data retention policy as you gave personally identifiable information.

7

u/JKTX30 Feb 08 '25 edited Feb 08 '25

UHC has entered the chat

For real though-- They are saying the have run into situations where they received a prior authorization yet insurance still refused to pay, and were told by insurance that even a prior authorization is no guarantee of payment. Unfortunately this kind of dishonesty is all too common in the insurance world so don't just try to discount everything people are telling you about their actual experience just because you haven't had the same experience yet

2

u/[deleted] Feb 08 '25

Who is They?

Most of your response was garbled, meandering, and barely intelligible. Are you drunk?

2

u/WorryFar7682 Feb 08 '25

AI is employed throughout the system. Not just the deliberate rigged claims processing that is skewed against the member. They don’t need a person to do it, it’s written into code and deployed.

1

u/[deleted] Feb 08 '25

Some forms of AI will help the medical system. Good example below that improves claims for lower denial rates.

Rules Engine | Pre-Built & Custom | Candid Health Automation

3

u/Savingskitty Feb 08 '25

This is not because they aren’t accountable for what they tell you.  Never accept that as an excuse, especially if they were giving you benefits for exactly the procedure you got done at exactly the provider that sent it in.

3

u/deathbychips2 Feb 08 '25

Right, because something might be filed with the wrong code or an insurance lapse by the time the service happens but if everything is the same as when you had the conversation and you call them out with proof of the conversation they cover it. They do it to see how many they can get away with because some people don't bother appealing

2

u/JeanLucSkywalker Feb 08 '25

That's so unbelievably predatory that it's mind-boggling. The only reason people won't bother is because they have been manipulated into thinking they can't do anything about it. I don't know how anybody who works at an insurance company can sleep at night.

1

u/[deleted] Feb 11 '25

I bet a few of them sleep very well when they know they do everything in their power to help people and to get claims paid. The post you're responding to was not very accurate.

1

u/JeanLucSkywalker Feb 11 '25

I'm sure some individuals who work at insurance companies are genuinely trying as much as they can. But the reality is that the system itself is set up to maim and kill people for profit, and there's very little any individual can do about that. They're still going to force you to do unethical things that should make any decent person feel terrible. I couldn't sleep at night working for a company like that.

1

u/[deleted] Feb 15 '25

I'm sure it depends on what type of plan someone works for. There are some pretty decent insurance plans out there that don't really require a lot of prior authorizations, medical reviews, referrals, etc. I agree that profit is the end game, Just like it is with the health care providers, and the employers to help purchase and create these health insurance plans.

1

u/[deleted] Feb 11 '25

Not every insurance company has a denial quota. I know I heard of rumors that UHC has a denial quota. But I also saw where UHC employees online were addressing saying those rumors were false. So what I'm saying is health insurance employees do not benefit at all from denying your claims. 9 times out of 10 the specific benefit information that was verified, procedure codes and diagnosis codes, ends up billed differently on the claim than from what is verified. Or just a billing error. It could be an invalid procedure code and modifier combination. It could be an invalid procedure code and revenue code combo. It could be due to the bill type not being a correct combo with the Rev code. It could be because the insurance company is requesting a coordination of benefits update from the member. It could be because the claims technician who was working your claim incorrectly denied it based on a misunderstanding. It could be that per CMS guidelines the procedure is determined incidental or mutually exclusive or global or inclusive to another procedure. It could be a claims processing systematic issue that the insurance company is facing and must correct. So so many things that it could be and not one of them include intentionally or wanting to deny someone's claim.