UnitedHealthcare Deletes Incriminating Chat

[u/One_Combination5776]

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?

[u/msp_ryno]

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

[u/deathbychips2 → u/msp_ryno]

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

[u/JeanLucSkywalker → u/deathbychips2]

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.

[u/[deleted] → u/JeanLucSkywalker]

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.

[u/JeanLucSkywalker → u/[deleted]]

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.

[u/[deleted] → u/JeanLucSkywalker]

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.

[u/[deleted] → u/deathbychips2]

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.