UHC Fleecing Customers?

Mar 9, 2016

  1. sk337sk337
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    sk337sk337 Expert

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    I was just emailed the attached image from an insured. I took some of their personal information out. I've had a few clients tell me their doctors were listed as in-network but now are being told they are not accepting this plan or something similar to the letter. Most of the people who are telling me about the issues are on exchange but no subsidy. We chose these plans BECAUSE they were their best option on/off exchange. (In East TN we only have two options: UHC or BCBS) How would you handle this? Is anyone else having this happen?
     

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  2. Tkruger
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    Tkruger Guru

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    Recently identified an issue with a client in NC. As of the enrollment UHC was showing Dr. accepting the plan. When we looked up the information a second time the Dr. was not there anymore.

    From what I understand Dr.'s can opt out of their contracts with the carrier at anytime.

    NC DOI is involved in that case at this time.

    I have a close contact in FL that has run into this with off X BCBS of FL. At the point of enrollment for a Jan 1 effective date he was positive that he searched his Dr.'s and enrolled in the plan...went to use in in Jan and the Dr. was no longer accepting that plan.

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    Daymn....read the attachment (wasn't there as I was posting) and it sounds exactly like what happened to my consumer.
     
    Tkruger, Mar 9, 2016
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  3. sk337sk337
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    sk337sk337 Expert

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    I know the Dr.'s can drop out anytime but this seems to state that the Dr's never agreed to this plan. My client feels like he was misled because his doctor still shows on their website as "in-network".
     
  4. AgentStone
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    AgentStone Super Genius

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    I directed my clients to contact providers before enrolling. What I had discovered is the online directories for the most part were inaccurate.

    I have a client who lives in a remote area that counted on her docs joining with the carrier she signed up with. The docs said they were in a holding pattern (during OE) but never made it in. Now the handful of in-network PCPs she could choose are not taking new clients in her area. The closest PCP is 25+ mls which is over 40+ mins drive time.

    I called the ins co... they said they will not make an exception unless there isn't a doc within 50 miles. Crazy distance to drive when you're sick :mad:
     
  5. sk337sk337
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    sk337sk337 Expert

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    I did direct them to the carrier and they were informed (as well as me) that the same list that is online is the same list they have in broker support/customer service.
     
  6. Tkruger
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    Tkruger Guru

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    Who is the source of the document? I understand your client sent it to you but who sent it to them?
     
    Tkruger, Mar 9, 2016
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  7. sk337sk337
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    sk337sk337 Expert

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    It was the Group that their doctor is a part of.
     
  8. kgmom219
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    kgmom219 What's Next?

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    Docs can come in and out of networks pretty much at will.

    The issue you are referring to is for carriers (and there are at least 2 that I know of) that created new networks for Exchange clients. Docs were sent the paperwork adding them to the new network. (Whether or not their reimbursement changed seems to be doc specific) Docs have way too many networks to deal with and probably just ignored it.

    And what the docs did not understand is that this was for On Ex clients.

    There are many, many docs who are refusing On Ex, for whatever reason. So when January hit and they realized they were in a network they wanted nothing to do with, they pulled out of the network.

    So we have clients that were told the doc was in network during open enrollment that is no longer participating.
     
  9. russelltw
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    russelltw Guru

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    Have a client in the same boat. Luckily for her, she is aging on to Medicare in a couple months...Doctor said after June, they are not accepting the On Exchange any more.

    Had another doctor office tell me they would not be taking a particular on ex plan because they were difficult to deal with. Even though they were still contracted with the carrier.
     
  10. sk337sk337
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    sk337sk337 Expert

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    I just don't understand why the doctors do not want the on exchange clients. Yes, some of them are low income but some I have are doctors/accountants who are not receiving any subsidy but went through the exchange simply because that was their best option.

    I have a few that are aging out now or in a few months and they can't wait to get on Medicare.
     
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