Anyone here with United Health Care in Northern California??

[cube_rat]

Insurance rant below

United Health Care bought Pacific Care about a year ago and the fallout in the bay area is ugly. There are a significant number of doctors on the peninsula (south of San Francisco) who have refused to sign the new contract with United Health Care after the acquisition. As a result, these doctors are "out of network".

Besides having a god awful attitude with the doctors and their practice staff, UHC offered rates to the doctors under the new contract LOWER than medicare!! I'm sure the doctors left in my area who did sign the new contract, are making up the lower insured costs with volume. Who wants to be in a cattle line?

Apparently this has affected employees from Oracle, Sun MicroSystems and XMega Corp (My company) and no one is talking about this situation at all. The employees at my company are paying part of the insurance premium costs out of their pocket and paying out of network on top of everything else. I have to "strategize"now from a monetary perspective for the tests my doctor ordered for some significant issues I'm having. Sorry, this is new thing for me. I've never had to "think" about going for tests that I need to have.

My options with Mega Corp? United Health Care or Kaiser.

Anyone else here have UHC PPO in Northern California?

 

[Sheryl]

Sorry to hear about the problems, Cube. I'm not in the area so I can't say anything specific about the companies you have to deal with. Would you be "in network" if you switched to Kaiser?

Having just gone through the hellish process of trying to renew our company's insurance for another year (facing a 17% increase when it was already costing us about 4% of our gross proceeds) I can only sympathize. I don't even know where to start with ranting about what is wrong with our healthcare system, but we've all heard it before anyway.

Frustrating as it is for us, it's even worse for those that don't have and can't get insurance at all!!

I hope you find a way to make the system work for you.

 

[wolf]

I retired from Agilent Tech. (was part of Hewlett Packard a few years ago). Under my retirement plan, United Health Care manages the plan. ( I heard through the grape vine, Agilent is self-insured and only has United Health Care manage the plan).

IN any case, you have my sympathies. I belong to the Camino Medical Group in Sunnyvale. Seems all of the doctors in this group take UHC.

Also, a fellow retiree, under the same insurer, United Health Care, belongs to Palo Alto Medical Foundation, so I assume they also accept United Healh Care.

From experience, medical insurance is a mess, each year the premiums increase or the decuctibles increase with higher co-pays.

good luck.

 

[mykidslovedogs]

Cube Rat

Are you saying that there are no longer any labs or facilities "in the network" that can run the tests you need in your area?. If that is the case, I'll bet you could call a "care coordinator" in the claims area to see what they could do about allowing (pre-authorizing) the claims as "in-network" - especially if there are no other facilities within a 50 mile radius than can run the tests you need.

A lot of times carriers will do that if there aren't any other doctors than can service you in your general vicinity.

Another thought is to contact the "coordination of benefits" dept and explain to them that you were in the middle of treatment when the changes were made, and you would like to speak with someone about being able to continue your treatment on an in-network basis until it is completed. There are some very good care coordinators whose job it is to specifically work with complicated situations such as what you are facing, and all it takes is a phone call to get one assigned to you. It might take a little time getting to the right dept, but it is well worth contacting claims for assistance. UHC has a dept in claims called "The Rapid Resolution" team, so if all else fails, I would call claims and ask to speak with someone in that dept. to see if you can get someone to help you out.

 

[kaneohe]

cube-rat,

are you Medicare-eligible or not? I am covered by UHC PPO in N.CA and
use PAMF in Palo Alto. Everything is fine now but when I become medicare-eligible, my understanding is that PAMF does not participate in HMOs if you are Medicare-eligible so I will either have to change doctors or enroll in the UHC PPO which has less generous benefits (No out of pocket max, etc).