United Healthcare, and apparently other health insurers, are routinely denying the federal law requirement for providing routine screening colonoscopies without a co-pay to patients.
When I was billed a copay by both the surgical group and anesthesiology group, I first called them. I wanted to make sure they correctly coded and submitted their bill to United, noting it was a 5 year "screening colonoscopy, " with no pathology found, no treatment required, and therefore no co-payment due from the patient. They did everything right, but when I called, they said: "This happens a lot."
I then called United. They said I could file an appeal, but they had 60 days from the date of receipt to make a decision. "If I pay my doctors on time, as I always do, and you decide you were wrong, will you refund my copayments?"
"No. Just don't pay them until you hear from us."
In the meantime, both medical groups were much more patient and consumer friendly. They said they would wait for the results of the appeal, and I did not have to make the payments until we all heard of the decision.
Guess what?
On the final week United had to reply to the appeal, it came through by mail.
"We decided to approve your appeal. We will make an exception for your situation, but we decided that our original decision about copayment is correct."
Seven bullet points were added, each denying they were wrong and trying to make sure that their decision was an "exception."
Indeed! Their exception—and payment—was made because a consumer cited federal law to them, filed an immediate appeal and included copies of their own policy regarding no copays for colonoscopy scrreening.
AARP should be ashamed—more responsible& than just granting a naked license and taking money for the use of its name when insurers behave as United Health has.
Further, where is the federal government's monitoring of private compliance with Medicare Advance Plans and the Affordable Care Act, the latter of which made this preventive benefit possible?
My guess is fewer than 1 in 10 who face this same situation will appeal. Hopefully, this complaint will send a message to other patients, to the federal government, to United Healthcare and to AARP.
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