Oct. 16, 2003

Covered, or not?

One of our children will have oral surgery in the near future, after her course of orthodontia is completed. We've been meeting regularly with the oral surgeon to plan for the surgery and its timing. At our last meeting with the oral surgeon (who is based in Albuquerque) we mentioned that our health coverage is changing to United Healthcare in January 2004.

We were worried that the doctor would flinch or grimace when we told him the news, but he did neither. Instead, he lowered his head into his hands and slowly shook it from side to side. He then related a string of horror stories his office has had with United Healthcare, dealing mostly with United Healthcare refusing to authorize a procedure or, worse yet, authorizing the procedure then refusing to pay and weaseling out through some loophole in the fine print. (He even recommended we try to purchase an extension on our Blue Cross/Blue Shield coverage to be sure the oral surgery would be covered.)

The prospect of the surgery was uncomfortable in and of itself, but now the prospect of having to wrestle with a health insurance company over payment sounds really discomforting. Assuming we get authorized for the surgical procedure, we intend to work with our Benefits rep to see how we can best protect against United Healthcare later reneging on the authorization.

So does anyone in the Human Resources Division have any statistics on how often United Healthcare refuses to pay for medical treatment they have authorized?

--John Gustafson