United Health Care Sucks

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Westcoast Joe
Regular Member


Date Joined Apr 2005
Total Posts : 130
   Posted 1/14/2007 12:10 PM (GMT -6)   
I was just forced to change insurance from Medica to UHC. I was covered for bags and supplies almost 100% with Medica and now I'm not covered at all. I pay the same amount , but UHC says they do not cover supplies that you can buy over the counter. The person i talked to on the phone told me that my condition is not major. I asked her if I should than make my own bags out of sandwich bags. She was not very understanding. My ostomie nurse told me to do everything in my power to switch away from United Health Care. She said they are the worst insurance in the business and the have gotten complaints from all kinds of patients. Has anyone had this problem? I really feel bad for those without insurance. My bill this month out of pocket will be 150.00. Life changes everyday. I have the option of getting the j-pouch. Do you guys with the pouch think thats a good move. Atleast i would not have to buy supplies. Thanks, Westcoast Joe    P.S. Atleast my Gopher hockey team is still #1

suebear
Forum Moderator


Date Joined Feb 2006
Total Posts : 5692
   Posted 1/14/2007 1:28 PM (GMT -6)   
I have a j-pouch and love it.  It beats life with chronic UC.  I suggest you visit www.j-pouch.org and learn more about the pros and cons of the j-pouch.  For me, it was the best decision.  I never did get along with my temp ileostomy.  But for others the j-pouch has not been a good decision.  I think the satisfaction rate is about 95%.
 
Sue
dx proctitis in 1987
dx UC in 1991, was stable until 1998
1998 started prednisone, asacol, pentasa, nortriptylene, ativan, 6MP, rowasa enemas and suppositories, hydrocortisone enemas, tried the SCD diet, being a vegetarian, omega 3s, flax, pranic healing, yoga, acupuncture, probiotics
2000 lost all my B-12 stores and became anemic
2001 opted for j-pouch surgery- now living life med-free
 


wmnak
Veteran Member


Date Joined Jul 2006
Total Posts : 1123
   Posted 1/17/2007 2:54 AM (GMT -6)   

Thanks for the heads up re: UHC.  I'm eligible for Medicare this spring and am looking at options for supplement insurance.  If anybody is really happy with their supplement company, please point me in a reliable direction.


cleo35
Regular Member


Date Joined Feb 2007
Total Posts : 430
   Posted 2/17/2007 10:03 PM (GMT -6)   
I would definately call UHC back and ask to speak with a supervisor! In addition, I'd ask my doctor to intervene and see if that would help. You could also consult with a lawyer who specializes in dealing with insurance coverage to see if they can find something in the policy that would force these idiots to cover your supplies. That really stinks - over the counter supplies? - what plant are these people on. There are very few ostomy supply "stores" as far as I can tell.

Shaz032
Forum Moderator


Date Joined Feb 2003
Total Posts : 1246
   Posted 2/18/2007 12:53 AM (GMT -6)   
UHC Insurance and their lack of paying for ostomy supplies is a well known issue and one the UOAA is currently trying to rectify. Read about it at http://capwiz.com/uoaa/issues/alert/?alertid=90260
                   

Good luck.


I have had an ileostomy for 31 years now due to UC.
 
Moderator of the Ostomy Forum
_______________________________________________
 
I'm not a complete idiot - some parts of me are missing!

Post Edited (Shaz032) : 2/17/2007 11:55:46 PM (GMT-7)


mrz.B
New Member


Date Joined Feb 2007
Total Posts : 5
   Posted 2/25/2007 5:26 PM (GMT -6)   
I recently changed insurance companies well, because our union did.( no choice) I pay up front and then send in the receipts. This was something I have done with the last three insurance co. It was never a problem until now. After sending in my copies they sent me a letter asking what disease I had. I explained that now I am disease free ( thank god ). My Crohn's disease is gone and so is my large bowl and my rectum. His reply was that's great, your better so why do you need ostomies supplies!!!!!. I know everone does not know or understand much about people in our situation. But I was completely dumbfounded. After spending 20 min on the phone trying to get a real person I got someone who really did not have the slightest idea of what he was talking about. He kept saying that they don't pay for supplies when there is no condition! After many trying moments and hair pulling I think that the message finally got thru. (he still had to go to the supervisior)

I have had my proctocolectomy since 1988, in halifax. from crohn's ddiease

cleo35
Regular Member


Date Joined Feb 2007
Total Posts : 430
   Posted 3/2/2007 11:20 AM (GMT -6)   
mrz.B: I think the problem here is that they've been led to believe your disease free when in reality, you're in remission. Your diagnosis is still crohn's. Have your doctor intervene on your behalf - he/she should be able to straighten these people out.

Beezo
New Member


Date Joined Mar 2007
Total Posts : 3
   Posted 3/5/2007 6:11 PM (GMT -6)   
WoW!!! i live in Manitoba Canada and all my colostomy supplies are
free .. and supplied by manitoba medical. i have a wall cabinet thats full of bags, clamps, adhesives, tapes, belts.... the only things that are not covered are the air release valves and the bag covers which i make myself. i have read that it can cost upwards of 90 dollars for a box of 5 bags...i think its ridiculous that some insurance plans feel they are not a necessity. i think thats the time i would show up at their offices without a bag on... and sit there every day until ive emptied ou all over their waiting room. ive a funny feeling they would rethink covreage real fast that way.

Glad Bag
Veteran Member


Date Joined Mar 2007
Total Posts : 699
   Posted 3/8/2007 3:10 PM (GMT -6)   
I know the bummer of changing insurance plans...I have changed mine about 4 times in the last 3 years. with a lapse of coverage here and there. It is always a nightmare. The worst part for me, most plans now have a new deductible plan for "self-injectable" medications. Previously, Aetna Health would only charge me my regular brand name deductible for Humira ( take 2 40mg syrings every two weeks) so I was out $40 a month. No big deal to feel better, right? Then I changed to Blue Cross, and now to Healthnet. Both of those companies have a 70/30 split for "self-injectables". At the current cost for Humira, which is more than Remicade, it costs about $5000 a month retail. While Humira is an awesome medication that has had more benefits for me than anything else I have ever taken, in over 15 years with Crohn's, I could not afford $1200 - $1500 a month for my share of the cost.

So I called Humira's Patient Assitance Program. They told me since I have insurance (good or bad, does not matter) I am not eligible for the Assistance Program, but they will help me with the approval process with my ins. plan.

The problem was not that my plan denied me, it is that the copay is too darn high, even with the approval. So, I asked for an appeal application and wrote a three page heartfelt letter to the program directors, and the CEO/Board of Directors for Abbott Laboratories (Humira's maker). Lo and behold, I received a call a few days later that they were "reviewing my application for an exception". Another few days later they called and have just sent me a FREE 3 month supply (that's 15K worht of medicine, just cause I asked twice)

I know it is a different scenario you are talking about, but at least the lesson is....give it all you got, fight the good fight, and you may win a battle or two every now and then.

By the way, if you have not heard of Humira as treatment for Crohn's, ask your doctor, it was just approved by the FDA this month for treatment of Moderate to Severe Crohn's disease, when other medicines have not been effective. Humira is basically the next generation of Remicade. It works the same way, but is more tolerated by your immune system, and so you won't develop antibodies for the medication itself.

Unfortunately, I had gone too long without it, and now I will have an ileostomy scheduled for April 20th, with or without the Humira.

I know inside that it will work out for the best but I am thinking about it everyday. Now I hear about the J-pouch deal and think maybe I should ask my doc about that.

but wait, that means revising the authorization I just received for the ileo operation from my healthplan!!! that was a pain to get that authorization to begin with....such is life, I suppose. just one foot in front of the other.....

whatever, you do, if you can buy Aetna Health insurance, do it, they were the best!!!!

I guess I will be going through all of these supply coverage issues soon, since my surgery is coming up....I wish there was a store you could shop at, not just online, where they sell al this stuff and you can look at it before buying it. I just want to go see this stuff ahead of time....

Talk to you all later......

Nathanael from Sunny Southern California

Westcoast Joe
Regular Member


Date Joined Apr 2005
Total Posts : 130
   Posted 3/8/2007 5:03 PM (GMT -6)   
Thanks everybody for your concern. I went and got another insurance plan from Blue Cross and before I did , I asked if I would be covered for bags. The answer was yes. I order 1 box and went to pick it up and the pharmacy said they do not cover it. I debated with them for an hour and Blue Cross said no way. Than 1 month later they sent me a letter and said they do not cover pre existing conditions. I just pay out of pocket and carry 2 insurances. Life hurts some times. Oh well I feel a lot better today than I did before the bag. I'm going to schedule my J-pouch appointment next week. As much as I appreciate the bag , its time to make the move. Atleast I won't have the costs of the materials anymore. My big fear is that they won't cover the surgery. If thats the case , I will stay the bag man for life.  Do most companies short term and long term disability plans pay for the J-pouch recovery. Does anybody know. I'm afraid they will call it an elected surgery. Thanks gang, Joe yeah

Glad Bag
Veteran Member


Date Joined Mar 2007
Total Posts : 699
   Posted 3/9/2007 11:46 AM (GMT -6)   
What a bummer about the insurance plans! As I understand it, the only way you can get out of preexisting condition exclusions in California is to join a group plan through your employer, there are other rules about having had to have had continuous coverage and such, but the rules are confusing and it is difficult to find one place you can learn about all these rules, let alone keep up with the changes that happen to these rules on a constant basis.

The worst part, as you know, is that you can ask the insurance companies themselves a question, but they give you a different answer every time you ask.

try going to this website, www.ileostomy-surgery.com or http://www.bcirostomy.com

They can perform a BCIR surgery. This converts a ileostomy into an internal pouch that you drain yourself with a small tube. It is pretty amazing. However, not everyone is a candidate. Their website says they help with the insurance authorization process. Give the doc a call.

I get my temp ileostomy in 5 weeks. Fortunately, I have insurance in effect and they will cover the whole cost.

Good luck and keep your head up.

dragonfly137927
Veteran Member


Date Joined Sep 2006
Total Posts : 2527
   Posted 3/24/2007 2:58 PM (GMT -6)   
Luckily I have blue cross healthmate as my primary insurance and my secondary is UHC through my husbands work what a pain that must be I have seen the prices on the items but luckily BCBS covers 100% of it
Dx with Crohn's 1987, symptoms as early as 1984.
Temporary iliostomy February 19 2007
Ovarian cysts dx 1994, migraines dx 1996, allergies (including food allergies) , oral allergy syndrome (sligtly different than true food allergies), Astham dx 1984, Gall Bladder removed 1999, Inguenal hernia Sx 1987
 
Protonix 40 mg, Nuerontin, oxycontin, dilauded, Folic acid 1 mg, Vitamin b12 1000 mcg, vitamin b6 100mg, Diflucan 100mg, vitamin A, Multivitamin, Elavil 100 mg, Zanaflex 4 mg, asmanex, singulair, foltix, probiotics
As needed: Albuterol inhaler, relpax, nebulizer (albuterol ), have an Epi-pen but hope I never have to use one.

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