Friday, June 03, 2011

Fraudulent Carrier Tricks: UHC and Medco

Fraud: A false representation of a matter of fact—whether by words or by conduct, by false or misleading allegations, or by concealment of what should have been disclosed—that deceives and is intended to deceive another so that the individual will act upon it to her or his legal injury. [emphasis added]

People wonder why health insurance carriers are held in such low esteem.

It's pretty simple: when you pull idiotic stunts like this, you will get bit in the behind.

We're all for consumer-driven healthcare, which means that we take seriously the idea that we should exercise good judgment when purchasing said care. My co-worker takes a certain medication which has gotten rather pricey, and United HealthCare recommended that she switch to the lower cost generic equivalent. Like many carriers, UHC outsources its prescription medication function to a Pharmacy Benefits Manager (PBM); in this case, that's Medco.

My co-worker saw the wisdom in this course of action, and went online to get pricing for the new medication. The Medco site specifically told her that it would be $33.12 for a 90 day supply (this in contrast to the $132 brand-name version). Since this represented a great savings (and since we're covered under a high deductible HSA plan), she immediately pulled the trigger for the $33 generic.

Imagine her surprise when, the next day, her credit card was charged for $153 - a 450% increase.

Is this fraud?

Well, look at the definition above, and draw your own conclusion.

My co-worker then spent quite a bit if time on the phone with the Customer NOservice folks, who assured her that they'd "look into it," and that she should call them back in 72 hours.

I had a better idea:

I contacted our service rep, explained the problem, and provided documentation. I also informed her that I needed resolution by 9:00 AM the following day. She did call me back, and told me that she had been told that the pricing my co-worker had been given (based on our plan and group number) was available only after she had met her deductible. Unfortunately for UHC/Medco, not only was none of this disclosed on the site, but clicking on the link "How is my cost determined" actually confirmed the $33.12 price tag, putting the lie to UHC/Medco's little dodge.

I had originally given UHC/Medco until 9:00 AM yesterday (June 2nd) to resolve this problem. Because I'm basically a fair guy, I decided to extend that by 24 hours.

Which has now come and gone.

And so:

First, this post alerting our readers that UHC and Medco seem to have no compunctions about bait-and-switch when dealing with med's, nor are they forthcoming with details as to how rx claims are adjudicated. This makes it impossible for insureds to budget, or to make informed decisions.

Next, I'll be calling the Ohio Attorney General, to report this apparent case of fraud.

Finally, I'll be calling my CongressCritter, and suggesting that this may represent a much bigger number of victims than just my co-worker.

Now you may ask: "Henry, why so serious?"

And here's my answer: I spend a lot of time and energy explaining to people why a gummint-run health care system is so much worse than one run by private industry. But this is no better than the stunts pulled by the MVNHS©. So tell me again why our system's better?

blog comments powered by Disqus