Help with vision insurance (UHC) — miscommunication.

April 25, 2024 2:21 PM

I got my vision test from a provider who was explicitly listed on my vision insurance (United HealthCare), but who denied the service. I called UHC and spoke with an agent, who called the provider, who said they did not accept UHC. The agent was mystified and told me to go ahead and pay $99 out of pocket, and they would reimburse me $99 as the provider was considered in-network.

Important note #1: I chose this provider as it was "under" Lenscrafters and right next door — convenient. Also, listed as in-network with UHC Vision.

Important note #2: I do not have UHC Dental or UHC general health insurance. Just their vision insurance.

Here is the timeline.

Early March: Called the provider to confirm insurance coverage. Was told they did not accept UHC Vision even though UHC's website listed them as in-network. Called UHC, agent called the provider and was told the same thing. As stated in the summary above, was told to pay out of pocket for $99 and that I would get the $99 reimbursed. Next day, I did so, paid $99. Frames/lens at LensCrafters were covered no problem at all.

A few days later: Called UHC and was told to fax in the receipt and explanation. Did so, called again to confirm they had received the fax. Was told yes.

Mid-March: Called to follow up. Was told they were processing it and to check back in late March.

Late March: Called in, was told to check in early April.

Early April: Called in, was told they actually never received my fax. Was placed on hold for two hours while they figured it out. Was given nonsensical answers/explanations. Finally got ahold of a supervisor, who instructed me to email her the receipt and that she would process the claim. Apparently, they never did get my original fax, even though a few agents seemed to think they did? I emailed it in and called it a day. Was told the claim clock would reset as it was considered received now.

Mid-April: Followed up with the supervisor via email asking when I should expect the $99 check. She responded, BUT it was sent in the form of a secure email form... with UHC Dental. Which I have no access to, as I am not an UHC Dental customer/member. No login information, nothing.

Emailed again, asked to send me a secure email via the UHC Vision secure email page. No response.

Today: Received a check in the mail... for $40. Apparently, UHC determined my provider to be out of network, even though they were explicitly listed as in-network and the original agent confirmed as such.

I am tired. This is ridiculous. How do I proceed? Any escalation paths? It should be worth mentioning that the UHC Vision team transferred me to the general UHC health insurance line so that was wasted time working with agents who couldn't help me, as only the UHC Vision team could. So frustrating.

I am disheartened because UHC Vision has always been my first choice, but now this happened. I have tried to be patient and had to explain the whole situation repeatedly.

Thanks.

posted by dubious_dude to Human Relations (8 answers total)

Are you insured through an employer? I'm in HR, have benefit responsibilities, and I would be lighting our carrier up about this for terrible customer service.

If you have employer sponsored coverage, then you should send an email to your HR team and say a much briefer version of what you've written above. (Stick to the hot points: you went to an in network provider for care, insurance has been giving you the runaround on reimbursement for two months.) In my position I would then forward your email to my account manager at the carrier and say "employee is having a significant customer service issue, please do an outreach to resolve ASAP." Your HR should be able to do that, too.
posted by phunniemee at 2:29 PM on April 25 [6 favorites]

And if your HR can’t help, complain to your state insurance regulator. That will be referred and get a higher priority at UHC.
posted by Sukey Says at 7:44 PM on April 25

For your future consideration, look into VSP if it is an option at your workplace. They have a lot more providers in your area.
posted by oceano at 11:01 PM on April 25

I don't have an answer for you, other than the suggestions above, but I just want to validate that you did nothing wrong. I remember your earlier question about this, even - you clearly were trying to do everything right! I need a new prescription and your questions have me wary about getting my exam at the Lenscrafters in my office building; one of the optometrists is listed as in network and the other isn't and that has me worried.

I have UHC vision and one year I ordered contacts from the UHC contacts website and they didn't cover the amount they were supposed to because they said those particular contacts weren't covered, even though they are clearly listed among the covered brands/types and I bought them on their own damn website. It was staggeringly dumb, but I had so much else going on at the time that I just ate the cost and gave up. I had a similar issue where my UHC-managed FSA refused to reimburse my prescription glasses purchase. That time I contacted the health insurance broker/management service that my employer uses to manage our benefits and they got it squared away really quickly. If there's any chance you have access to that kind of help, definitely use it.

I honestly think the system is built this way intentionally to make us give up and not get the full breadth of the benefits we're entitled to.
posted by misskaz at 4:28 AM on April 26 [1 favorite]

Response by poster: Thanks! The $59 difference won't break the bank, but it's the principle — being told I would be reimbursed the $99 in full only for them to turn around and reimburse less than half of that, plus the associated runaround.

Yes, my vision insurance is paid through my employer. I'll try the HR option and failing that, perhaps the state insurance regulator. One wrinkle: Does DC have a proper state insurance regulator?
posted by dubious_dude at 5:47 AM on April 26

Insurance has always been weird to me. I had had a similar experience to yours. My gastro was referring me to another gastro, and I called up the new gastro s office, only be told they don't take my insurance. I checked the insurance provider's specialist directory, and he's literally first guy on the list! I 🤔
posted by kschang at 11:12 AM on April 26

This is more future advice but... in these sorts of conflicts, I always go with what the provider says, not the insurer. The provider is the one who is going to submit the billing to insurance, and it is highly unlikely that any person you speak with at the insurance company is going to be the same person involved in the other end of the process. I have never found it to be the case where a note was left in the "file" or whatever and that actually happened or made any difference.

For whatever reason, that particular provider did not want to be in-network (as in, they did not want to be subject to a contractual agreement regarding the cost of your service) and the fact that UHC Vision gave you an out-of-network reimbursement suggests that there is a disconnect between the in-network database and the providers. This has happened to me a handful of times, which is how I came to the first point.

Yes, this all sucks. Good luck in getting your resolution!
posted by sm1tten at 1:30 PM on April 26

Here's a funny follow-up to my own tale of insurance mis-adventures. Remember I said the new gastro's nurse said they don't take my insurance? I had immediately called my doctor's office, they within 48 hours found another provider, someone who's closer (and more convenient), who's so accommodating, they got me in for procedure next week.

3 days before the procedure, the gastro's nurse (who previously told me they don't take my insurance), called me up and told they they'll be happy to book me now. Sorry, I booked with someone else already, thanks! (cue: Sad trombone)
posted by kschang at 2:42 PM on May 8