Experiences with united healthcare
I am hopefully starting a new job soon, and their health and vision insurance is UHC. We can also choose a regional plan (UPMC for anyone in the western PA area) through my wife's job.
All my previous employers have been local, so we've always had UPMC coverage. This is my first time dealing with a national insurance company.
Likely my new plan will be be less expensive and have lower deductibles than my wife's.
Pittsburgh is split between UPMC (a hospital system that grew an insurance arm) and AHN (an insurance provider who grew a hospital system). Ironically, UHC may offer me more options since they seem to have most of the UPMC and AHN providers in their network.
I've checked all my doctors and the major hospitals, and they are all listed as in-network. I'm already getting my maintenance medications through CostPlus, so I'm not that worried about prescriptions.
My wife and I are in our 40s and relatively healthy, but I know we are reaching the point where (statistically, and looking at friends the same age) we're likely to have some big health events in the next five years.
Outside the very obvious news story that comes to mind when thinking about UHC, what are your experiences with them? Things to watch out for? Things you wish you knew going in?
Edit: thanks everyone for your input. This largely confirms my expectations, but I appreciate people taking the time to share.
My cousin had United in New Jersey. The good: she did find a PCP in her area, and the PCP did have appointments regularly available.
The bad: she could never get a comprehensive appointment with him; each appointment dealt only with a single issue, with no real consideration of other factors. Like, she could see him about her allergies, but if she also wanted to go over her thyroid problem, that had to be a separate appointment, that kind of thing. It very much felt like the doctor was maximizing whatever they were paying him. He was decent about continuing to prescribe existing meds (not sure if she got put on any new meds) and giving referrals to specialists.
Specialist referral was where everything went wrong. UHC had a massive book of all the doctors "in their network". Her PCP would give her a referral for something - let's say an annual obgyn exam. If he recommended a specific doctor, she'd call them, only to find out that they no longer accepted her coverage, so she'd start calling the doctors listed in the book, only to find that almost none of the "in network" doctors accepted her plan. The very small handful that did still accept it weren't accepting new patients.
She called UHC customer service to find more doctors who were in-network and accepting patients; absolutely the only thing they did was read her names and addresses from their book, despite her repeatedly telling them that those doctors no longer accepted her plan or weren't accepting new patients. UHC just told her to keep calling the doctors listed in the book.
She called literally every obgyn listed in the book for New Jersey, trying to get an appointment. It took her hours and hours, over a period of days. There were only two obgyns that were still in-network and still accepting new patients - and they were literally three hours away at the other end of the state - like she lives in Cape May county and the doctors were in Sussex county. Plus they wanted her to make two separate visits to the office, at least a week apart, and they insisted that any bloodwork or mammograms be done locally to them. And I think one of them didn't have appointments available anytime in the next six months?
Every referral was like that: no one took her insurance (despite being listed the The Book and despite customer service saying that they were) or they weren't accepting new patients. She had to do everything herself, manually. It took a lot of time and a lot of effort, day after day spent on the phone. She moved off UHC as soon as she could.
I dunno, dude. Maybe it's different in Pennsy, maybe things have changed, maybe it's a different kind of plan. But you might try calling up some of those doctors listed in the book and see if they're actually accepting whatever your insurance will be - and also accepting new patients, and when y'all might be able to get an appointment with them. My cousin was in tears with me because she kept bleeding and couldn't find an obgyn to take her for months, and it was literally at the other end of the state.
She's with Horizon BC/BS now, and much much happier.
If it's anything like BC/BS, it's lower than the medicare rate. BC/BS pays in-network providers according to their 'established rate' which is some bullshit they made up along the lines of 'average rate we pay out for this service, based upon what we pay out for this service.' For my psychiatrist, that came to the tune of like $95, when medicare pays out like $140 for a $200 billing.
I had a half-decent PPO plan from BC/BS, and when he stopped accepting them, he ended up getting paid $160 and I paid $40. I was happy to be paying double my copay to make BC/BS pay more.
This is horrifying. I've had more than a few dark thoughts about BC/BS when resolving claims. It surprises me even more that Luigi was the first.
I had a similar experience on UHC but also Aetna. Extremely hard to find a provider, and no help from the representatives beyond a list that they expected me to call each office, and see if they were taking patients.
I am not sure what the point of having a gigantic network if it's so hard to even make use of it. Most of the time I had to wait multiple months (some cases over a year) for super basic appointments.
If you can't get a doctor to see you, they don't have to pay.
The gigantic network is the selling point, it's just often fake on paper. I've seen this with my partner's Medicare via Humana - look up therapists on their website, get everything from Psychiatrists to doctor's offices that don't have a therapist to people out of business. They're not motivated to keep those referral lists current because big network looks better.
UHC is widely considered the most evil of the health insurance companies. Highest denial rates, they've used AI to deny claims, a crap ton more.
There's a doctor that has a side-gig as a YouTube activist/comedian: Dr. Glaucomflecken
Here he is on his favorite subject: the evil things UHC does.
That video is a great summary, but doesn't mention that UHC also owns medical practices with thousands of providers, operates an IT outsourcing company that brings in even more money from the U.S. health system, and bought the primary transaction management provider, Change Healthcare, for over 50% of all medical billing transactions. They really are the "most evil" in terms of oligopoly profiteering.
...UHC are fine as long as you don't use your coverage, are comfortable scheduling annual checkups several months in advance, and don't mind a several-week denial song-and-dance between your pharmacist, insurer, and physician whenever you first fill or renew a prescription...
...for acute treatment or special exams, expect an automatic denial-and-appeal followed by several letters and calls before UHC acquiesces to pay their minor portion of the cost; top practices handle that for you and build their administrative cost into your up-front payment, which won't apply toward your deductible...
...anything you pay which is not covered, administered, and pre-approved by UHC typically won't count toward your deductible, and most in-network practices also include out-of-network specialists which you won't discover until your billing comes through, despite hours of advance research and coordination...
...UHC's business model is build upon denying healthcare, not providing it, and they plan for automatic denials to wear down a large portion of abandoned claims by attrition of patients too exhausted to spend hours fighting for coverage, before they finally relent to satisfy their obligation...
...i've had UHC for thirty years and eventually learned that it's cheaper for me to tell doctors upfront that i'll pay cash-out-of-pocket than to do the whole UHC dance and pay even more to cover their administrative costs; i've since reduced my policy to catastrophic emergency coverage only and mostly ignore it...
...UHC works best if you're comfortable just forgoing health care and living with anything that's not catastrophically disruptive...
Had United briefly, sprained an ankle, urgent care doc sent me in for an X-ray just to rule out the unlikely chance of a hairline fracture, still got billed $800ish after insurance.
With the most routine and banal of the sports-related injuries, you'd think it would be a no-brainer as to who covers what parts of the costs. Nope. Total black magic to them. Would've totally shrugged my shoulders at $200. Nope, gotta gouge it at fucking $800.
I just took my beating and left. I shudder to imagine what it would be like with them if I was in a car crash.
The Nintendo character did nothing wrong.
I'm the one who posted this screed about UHC.
I'm in a small city surrounded by a rural area, so both primary and specialist care are in short supply. Neither my spouse nor I could find primary care providers in-network; those visits are essentially out of pocket until we meet our deductible. My rheumatologist joined the local hospital system, so he's now in network at $50 a visit. There are no cardiologists within 200 miles who are in-network and taking patients. My spouse's ongoing specialist care post-heart valve replacement is essentially uncovered. [He had his urgent heart surgery while we still had Humana coverage, and there were no questions or delays in getting treatment approved. He had about a year of wrangling over $1,000,000+ billing, but ultimately we only wound up about $4,000 out of pocket.]
We make full use of my employer-sponsored flexible spending account every year. I highly recommend setting up an FSA for families with even moderate care needs in the current insurance environment. An FSA means you can use pre-tax earnings to cover deductables and co-pays, but the money set aside is use-it-or-lose-it. Best if you know how much money you're likely to spend.
On the good-ish news side, we haven't had problems with prescription drug coverage, including the very expensive specialty biologic medication I'm taking (after the UHC-required lengthy process to get it). Though I'm using a generic biosimilar, it's nearly as expensive as name-brand Humira because of UHC's pharmacy benefit management shenanigans, so it's costing my self-insured employer far more than necessary ($100k/year vs. $10k for the lowest cost generic). I know it's not legal, but I have a paranoid suspicion all the time that I could lose my employment for being too expensive to cover.
Even though my ortho surgeon was in-network, he didn't have his preferred choice of where the surgery could be performed. After the surgery was finally approved, I also had to pay the ortho surgeon a $5,000 cash deposit in advance that was ultimately refunded when UHC insurance paid out three months after the surgery. I don't know if requiring a deposit is legal or not, but I wasn't in a position to argue. This sort of extortion would be a huge burden for most families, and it's another reason to take advantage of an FSA (or HSA if you choose a high-deductible plan).
Edited to fix my error over HSA vs. FSA.
...i think you mean FSA (flexible spending account); HSAs are an entirely different beast fraught with coverage and accounting complications, best suited as a long-term investment vehicle for people with negligible near-term healthcare costs...
You're right, I've got them swapped and will edit accordingly. The mistake is deeply annoying to me because I literally made the FSA election during open enrollment this past week.
...the most frustrating aspect of the HSA/FSA dichotomy is how the rules are transitive across both spouses regardless of separate health care plans: for example, since i've quit using my UHC coverage i'd be an ideal candidate for an HDHP/HSA arrangement, but since my wife's health care costs (and coverage through her employer, a pharmaceutical company) are formidable, she needs (and fully exhausts) her FSA each year, which disqualifies me from contributing to my own HSA...
The most frustrating thing is that there is no tangible reason for the FSA to exist. It's entire benefit could be replaced with raising the minimum wage by somewhere around $2 or adding another $3000 to the standard deduction.
But instead, it's more important to have a complex and hard to use system to avoid the off chance somebody could use that money to pay for rent.
The standard deduction itself is also a curious bit of insanity which would be easily solved by shifting the tax brackets by its same amount. But that would make it too obvious that we don't need to tax anyone earning less than $25k, which would make people wonder why federal minimum wage isn't at least $20 an hour.
The deductible is there to discourage using health services "unnecessarily". It's part of the problem with applying the insurance model to health. Everyone needs medical treatment at some point in their lives - it's not an adjustable "risk" in the same way as car accidents and floods.
I don't know about anyone else, but emotionally I'd rather hit myself with a hammer repeatedly than experience the delights of stripping naked before strangers, being poked with needles, prodded in uncomfortable places, having broken/damaged parts yanked around, and taking drugs with exciting side effects...
Being relieved of large sums of money too just adds insult to non-figurative injury. I have difficulty imagining (non-mentally ill) people using health care without really, really needing to. More often, they don't get care when they should, and wind up costing far more in emergency treatment and hospitalization. Health care should be a social obligation that we all undertake to assure that we're as healthy as we can be as members of a commons of concern for each other.
The revenue act of 1978, which implemented FSAs, did increase the standard deduction /reduce taxes on the lower income brackets.
I think a more charitable explanation is that passing legislation is extremely complicated and so lawmakers tend to add new programs which they know they can get passed in lieu of trying to untangle the byzantine spaghetti of modern legislation.
I think the FSA is a pretty good example of that, actually. The FSA was created to try to fix the problems that turned up in a prior iteration of a government program, the HRA. The goal of the FSA was to move the benefit from the employer to the employee (the primary tax benefits of the HRA having been reaped by employers) and give workers more control over their finances and health care. It was a pretty well-intentioned piece of legislation.
I certainly agree with you that the minimum wage should be much higher.
Ugh this scares me so much, as I have UHC and use the HSA because while I'm at the age where I should be seeing a PCP on the regular, I typically am pretty healthy and don't require any medical services...
But if I do, I'm likely gonna hurt bad. Like everyone else using UHC...
I understand the anxiety, but please don't put off routine medical care, regardless of what insurance is involved. My apparently robustly healthy spouse would be dead if he hadn't gone to the doctor for feeling "a little tired" after lumberjacking as a hobby (!). He'd been walking around for 50 years with a congenital heart valve defect that had calcified to the point where his cardiologist arranged surgery within two weeks at the peak of the COVID-19 pandemic.
That's an extreme example, but going for routine care on a regular basis helps establish a relationship with a doctor who can guide you to better self-care. If you start when you're healthy, it lets them understand your baseline to quickly spot and manage any health declines.
I have for my 47 years of life, because all the times I have had health care that would cover stuff only failed me on every level. I've been misdiagnosed so many times with so much bullshit that honestly, even my tenure where I had to get checked by military doctors did at least enlighten me a bit, (and to that aspect, huzzah?)
I'm glad your spouse had a better outcome. Mine is entwined with the VA and that's a whole 'nother shitshow, but at least it isn't related to my healthcare options! (UHC)
Keep a written log of every communication you have with them.
Date, Day, Time, Minutes On The Call, Who You Spoke With, And What They Told You.
When you find the need to fix an issue with them recite your last log entry to them so that they know you are tracking them and will not go away.
Keep every receipt.
Use GrapheneOS and record every phone call, especially if you're in a 1-party consent state.
I often just say 'you too buddy' when they tell me I'm on a recorded line.
Finally, a use for my reflexive "thanks, you too".
In seriousness, though, quick reference for which states have 1 party recording consent. https://worldpopulationreview.com/state-rankings/single-party-consent-states
No useful input about United, but this caught my eye
Actuarial people know this, and that's why term life insurance premiums have a big jump after you hit 45. Consider getting a T10 or T20 if the unfortunate (and hopefully extremely unlikely) demise of either you or your spouse will financially devastate your children's future. There's also a hidden benefit in that a good convertible policy will mean the next time you renew your policy they won't be asking you awkward questions about if you have severe illnesses that you picked up / have manifested during the last term.
Good advice! We both have pretty good life insurance policies.
The truth of the matter is: it varies. A lot. Insurance companies are far from the monoliths people think of them as. The coverage and experience you get is going to depend entirely on the contract you're under(which is largely dictated by your employer.)
UHC, like any other health insurance, can be good, or it can be awful. They're the largest health insurer so there's a broad range of variance. You can be on UHC commercial, which is what you'd end up on, or Medicare or Medicaid, and the coverage and network will be different. Sometimes the coverage can be different within those lines of business depending on which part of it you're in. It's very complex and confusing.
I've had UHC insurance for 10 years without any major gripes, but I also work in healthcare/health insurance, so my ability to navigate the systems I would say is considerably higher than median, and that could be impacting the experience.
A lot of other commenters issues with finding in network physicians is almost certainly an issue on the provider not properly running the insurance, or the customer service not understanding the coverage network. A doctor can be in network for NY Medicaid CAID but not NY Medicaid essential plan(the Medicaid expansion part). I encourage people to use the insurance website to find a doctor, then call, then explicitly ask if the MD office says they aren't in network, for them to check their internal systems (since everything communicates). The idea of a random MD office not accepting every commercial insurance is laughable, as even the worst UHC commercial is paying more than Medicare rates
In other words: Probably shitty unless you're a union employee with some degree of bargaining power.
Generally, I think size of company matters more than union, though certainly a union can help. A bigger risk pool typically gets you a better plan. Also education/universities tend to offer very good plans, as I guess an employee retention tool, or it's easier to get nicer health insurance approved than raises, something like that, but that's my experience/knowledge on it.
Public universities (for insurance purposes) function as a large group: state employees or at the least university employees. So yeah it's a pretty large population to work with. But my copays are still too expensive to do PT with at the regularity they want. So eh, pretty much everything is covered, I'm just being copay'd into not taking care of me.
We’re on a PPO plan and In my experience they’ve been good. We had a baby while covered by UHC and my wife has a health concern that would be very expensive to treat without coverage. Granted, we live in an area with a lot of health care options, but we’ve basically been able to go wherever we want, be in network, and have not yet had to fight any claims.
The only issue we had was them not wanting to give us a non-standard refill window on new-ish name brand speciality medication. And I’m not convinced another insurance provider would’ve done so either. They also barely paid anything for our medications before our deductible was hit. You mentioned not being worried about prescriptions, but wanted to mention for others reading the thread.
In any case, it’s been pretty much the same compared to my last job with insurance through BCBS.
YMMV
I had UHC for several years when I was living and working in Kansas City. Typical PPO plan. Think my deductible was like $1000.
I had no issues. That said, I don't have any major health issues (that I'm aware of). So it was just going to my GP for checkups or when I had some typical ailment. My doctor, who had I been going to since I was a teenager, was in-network. I think the only specialist I went to was a dermatologist a couple times for a biopsy and Rx. Only thing that was annoying with the dermatologist was just like 4wk wait, which was annoying, but my old dermatologist was like a 3mo wait. Either way, not UHC's fault. No issues with either doctors. I never had any issues with any prescriptions not being on a formulary. But I think any Rx I had at the time were generics anyway.
During that time, I had one surgery: getting all my wisdom teeth removed. No billing issues with UHC. Some confusion over the deductible on my end (this was the first surgery I had as an adult, so first time dealing with this stuff beyond routine health visits), but I took care of it with the oral surgeon.
I was actually pretty happy with UHC. To the point I was surprised to hear about all the shit UHC pulled on people after Luigi Luigi'd the CEO. But again, I didn't deal with catastrophic or life-threatening health issues. Regardless, all that was a factor in my switch from my UHC PPO (different plan, different geographical location, different employer, from previous UHC coverage if it matters) to a HDCP with Aetna for 2025.
I have UHC and it's fine since I never have to actually use it. My doctors that I'd been using my whole life were in network. I just use it for my yearly checkups and that's it.
Coming in late but want to share. I got our little startup a United PPO as it was the only carrier that I could get that would provide a plan for 5 people across 4 states. It's been fucking awful.
I picked up a prescription and the pharmacist literally said "wow, I've never seen such a bad co-pay for this medication. You need to talk to whoever handles plans and see if they can change. For most people this is free and you're getting $5 covered." To which I had to cop that I was the one that had found and selected the plan.
I was "assigned" a doctor in my area and when I tried to make an appointment it turned out I wasn't assigned, they just picked someone in my area that took United and had them listed as my primary. I was told they weren't taking new patients and to find someone new. It took me 9 months to get a primary and that's only after a Dr at urgent care referred me so I could be an "active patient" vs a new one.
I've also been chronically constipated about 6 months for every year for the past 3 years and went to the GI specialist to try and figure it out. I ended up getting a blood work panel done as part of that which United then denied as necessary and I had to spend $2000 out of pocket to cover it. It didn't even count towards my stoploss. I've never experienced that before even with my shit insurance in college.
I also went on a new medication for ADHD, which I ordered at CVS. It was $200 so I decided that monthly cost was going to be a no from me. I got told that costs were cheaper if I ordered through Optum (United's by-mail pharmacy) so I got an prescription for a different version but when I saw the price online I never ordered it. It came anyway because a prescription had been put in, and when I said I didn't want it they refused to take it back - envelope completely unsealed - and refused a refund.
Also, my copay for a follow up after breaking my toe in japan was more money than paying in cash in Japan for a doctor to assess it, x-ray it, reset it with 2 other staff, x-ray it again, and give me crutches. All the follow up did was wiggle it once and say it was fine. WTF.
I think many of my qualms are with our medical system in general, but fuck United specifically. They have been a high deductible, high co-pay, frequent denial, absolute maze of a system to navigate. I know it's contentious but when dealing with them I fully understand why Luigi did what he did.
I mentioned this in the post, but CostPlus has been great for me. Brings the cost for my meds down from $85/mo to $80 for three months. That's without any insurance reimbursement. Their mail order service has been very reliable, and since it's not through the insurance, I can order it ahead to make sure I have plenty on hand.
I guess the downside is that cost doesn't go against my deductible, but we usually hit our deductible anyway. Nevertheless, if you can tolerate a generic I highly recommend checking it out.
I just rechecked CostPlus and they're now carrying biologic drugs. $500/month for a medication that's costing my employer $8,000. Still expensive, but far less frightening if I lose my job or quit.
I have United PPO.
Decades ago they used to be excellent. In the last 5-10 years they have been more aggressive about denying expensive diagnostic tests.