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UnitedHealthcare taught us ways to deny claims: Former employee
- Thread starter Duaine
- Start date
I have seen 3 different videos of her story, all slightly different, and some things do not add-up for me. My feeling is that at best she is being biased toward her side of the story, and at worst she is outright lying. Disclaimer, I have been a group benefits wholesaler for 42 years and specialize in self-funding.
In another video she explains that she works for UMR, which is the self-funded arm of UHC. Consider the following statements she has made.
1. "We had to memorize 1,000's of plan designs". While it is true that they may have been managing this many plan designs, it is doubtful that she was required to memorize them. It is all computerized. Even before computers automated all of the claim payor work, a claim payor would not have been required to memorize them.
2. She states that at certain times there was not sufficient amount of dollars to pay the claims that a member was calling her about. OK, that may be true, but in a self-funded plan that is usually not a carrier issue but rather the employer not funding the plan.
3. In another video she discusses how she was given a pot of money, $400,000 from which she could pay any claim(s) at her discretion. In this video it was the situation with the pancreatic cancer family, she went into their claim and paid it. Then logged off and quit. Very highly unlikely that she would be given the authority to spend that large of an amount at her discretion after only 9 months on the job.
4. Since the group is self-funded where did the additional $400k come from to pay discretionary claims? She is saying that it came from UHC. Why would UHC give a self-funded group monies to pay their claims? And, if in some fantasy world that the UHC did give her money to pay claims of self-funded groups this would be magnanimous of them and would be undercutting her claim that UHC does not care.
In another video she explains that she works for UMR, which is the self-funded arm of UHC. Consider the following statements she has made.
1. "We had to memorize 1,000's of plan designs". While it is true that they may have been managing this many plan designs, it is doubtful that she was required to memorize them. It is all computerized. Even before computers automated all of the claim payor work, a claim payor would not have been required to memorize them.
2. She states that at certain times there was not sufficient amount of dollars to pay the claims that a member was calling her about. OK, that may be true, but in a self-funded plan that is usually not a carrier issue but rather the employer not funding the plan.
3. In another video she discusses how she was given a pot of money, $400,000 from which she could pay any claim(s) at her discretion. In this video it was the situation with the pancreatic cancer family, she went into their claim and paid it. Then logged off and quit. Very highly unlikely that she would be given the authority to spend that large of an amount at her discretion after only 9 months on the job.
4. Since the group is self-funded where did the additional $400k come from to pay discretionary claims? She is saying that it came from UHC. Why would UHC give a self-funded group monies to pay their claims? And, if in some fantasy world that the UHC did give her money to pay claims of self-funded groups this would be magnanimous of them and would be undercutting her claim that UHC does not care.
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