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Thread: Problem with UnitedHealth insurance company

  1. #1
    Senior Member foton's Avatar
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    Problem with UnitedHealth insurance company

    Hello,
    I need an advice from forum members. I do have a serious problem with insurance firm and I do not know what to do and where to start.
    I was lied off three months ago after 6.5 years with IT company. I used COBRA to continue my benefits during this three month period. Finally I got a new job with some additional perks like health insurance. The new insurance is through UnitedHealth. The deductable is high, $1000, but the tab is covered by my company. I got special creadit card with $1000 limit for this purpose. I did not change DME provider, EdgePark, which I have worked with them for the past 2 years since they are in UH network. On Thursady I got my urinary supplies and I called them to pay for them with my new card. And this is the moment when I got cold shower. EdgePark said my current program does not cover incontinence products, leg braces, and wheelchairs !!!!!!!!! Currently, I do not have need for braces or wheelchairs, but I need my incontinence products. I called UH few minutes ago and they said my benefits do not cover disposable urinary products. They suggested to file the complain. This is crazy. It looks like my insurance is a piece of junk. What can I do in this situation? I can not change the job now and I do not want to talk to my CEO about my problems. On the other hand..... is UH right to exclude incontinence products?
    I appreciate your input. thanks.

  2. #2
    I have to pay for my cath's out of pocket, then send my reciept to my insurance company for remimbursement. It gets filed under major medical not thru my drug card company. My drug card company said that they did not cover such items, but after talking with my Human Resorces person at work along with a call to the insurance company, I was told that such items fall under major medical.
    SCI Birthday: April 25, 1993
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  3. #3
    I wouldn't think intermittent catheters are classified as "incontinence products". I would call UH again and explain you have a prescription for catheters.


    Quote Originally Posted by foton View Post
    Hello,
    I need an advice from forum members. I do have a serious problem with insurance firm and I do not know what to do and where to start.
    I was lied off three months ago after 6.5 years with IT company. I used COBRA to continue my benefits during this three month period. Finally I got a new job with some additional perks like health insurance. The new insurance is through UnitedHealth. The deductable is high, $1000, but the tab is covered by my company. I got special creadit card with $1000 limit for this purpose. I did not change DME provider, EdgePark, which I have worked with them for the past 2 years since they are in UH network. On Thursady I got my urinary supplies and I called them to pay for them with my new card. And this is the moment when I got cold shower. EdgePark said my current program does not cover incontinence products, leg braces, and wheelchairs !!!!!!!!! Currently, I do not have need for braces or wheelchairs, but I need my incontinence products. I called UH few minutes ago and they said my benefits do not cover disposable urinary products. They suggested to file the complain. This is crazy. It looks like my insurance is a piece of junk. What can I do in this situation? I can not change the job now and I do not want to talk to my CEO about my problems. On the other hand..... is UH right to exclude incontinence products?
    I appreciate your input. thanks.

  4. #4
    Quote Originally Posted by t8burst View Post
    I wouldn't think intermittent catheters are classified as "incontinence products". I would call UH again and explain you have a prescription for catheters.

    Yeah - ask for clarification from your insurance, and ask to speak to a supervisor.

    Typical "disposable incontinence products" are chucks, pads/diapers etc.. and no one covers these. Usually catheters are put in a different category. If a supervisor still says no, then ask them if it is possible to appeal if the catheters are "medically necessary" for your health and ... survival! Then also call the person at your company that manages the health insurance. If your employer actually administers your health plan, sometimes they can help arrange coverage for you.

    You never know until you try.

  5. #5
    Yup, this was me being switched from BCBS to UH back in 2009 and getting the cold realization that catheters were not going to be coverred:

    http://sci.rutgers.edu/forum/showthr...ight=catheters

    Now, almost 4 years later, and I get by with reusing catheters. I probably use about 4 per month, if that.

    On the plus side I actually never get UTIs. I seem to have developed superhuman resistance to infection. I credit this to United Healthcare...thanks guys!!!


  6. #6
    Senior Member foton's Avatar
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    I will try to fight it, but it looks I lost this battle. I will appeal the decission, but it looks like my company got something really basic. I even did not know you can have something like this. I use external caths only. My monthly supply would cost me over $260 per month ( 32 caths, 3 leg bags, and one night bag). And this is price after 40% discount. There is no way I can afford it with or without discount. What is also bad they will not cover wheelchairs or any expenses related to their maintanance.
    Still it is strange for me that insurance firms can deny incontinence products like caths or leg bags. I always thought that with letter of medical necessity they will cover it. I am really screwed.

  7. #7
    Quote Originally Posted by foton View Post
    I will try to fight it, but it looks I lost this battle. I will appeal the decission, but it looks like my company got something really basic. I even did not know you can have something like this. I use external caths only. My monthly supply would cost me over $260 per month ( 32 caths, 3 leg bags, and one night bag). And this is price after 40% discount. There is no way I can afford it with or without discount. What is also bad they will not cover wheelchairs or any expenses related to their maintanance.
    Still it is strange for me that insurance firms can deny incontinence products like caths or leg bags. I always thought that with letter of medical necessity they will cover it. I am really screwed.
    Look at other mail order / online vendors. Edgepark is stupid expensive.

  8. #8
    Senior Member McDuff's Avatar
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    Quote Originally Posted by -scott- View Post
    Look at other mail order / online vendors. Edgepark is stupid expensive.
    ^this, try www.exmed.net for a reference. They don't do insurance, just cash, way cheaper.
    "a T10, who'd Rather be ridin'; than rollin'"

  9. #9
    Quote Originally Posted by McDuff View Post
    ^this, try www.exmed.net for a reference. They don't do insurance, just cash, way cheaper.
    I've ordered from express many times and have never had a problem with delivery or errors on my credit card.
    I'd recommend them.

  10. #10
    I know all plans are not the same but I have had United for over 10 years now and for me, at one time the catheters were covered and then they stopped covering them and now once again I understand they are covered. I was contacted by one of the peddlers from the monthly mail order places telling me I was now eligible with United to received my supplies from them monthly, I said NO thanks. I just purchase mine on the web and pay for them (I reuse them and have had no problems), I spend around $80 a year on them. Although it is a LONG process, I have had NO problem with United paying for my wheelchairs

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