wallachs Date Rated: 4/12/2017 10:56:16 AM
UNITED HEALTHCARE MAKES MANY MISTAKES AND REFUSES TO HONOR THEIR PROMISES AND WRITTEN POLICIES
The plan's 2017 preliminary (abbreviated) drug list "Formulary" received in September 2016 did not include my blood pressure medicine which they had covered for many years as a Tier 3 drug. I called United and their representative assured me that it would be covered in 2017 same as previously. Although she could not send me written verification of this, she gave a case number for future reference and promised to send the full formulary list to me. When it arrived in October, my medicine was still not shown, so I called again and spoke with a different United representative (a manager) who again assured me that it would be covered as a Tier 3 drug since he was looking at the official formulary list of approved drugs. He gave me another case number and promised to send this to me in writing, but never did. Based on these multiple representations by the company's agents, I resubscribed only to find out in January that United refused to cover the medication because it was not in their formulary. I again contacted the same manager, who agreed to file a grievance on my behalf based on his and previous errors (which he did). At the time, he also said that the grievance would be automatically denied and he would then file an appeal (all of which he did)
The grievance and the appeal were both denied and I had finally to get a letter from my physician stating that it was imperative that I receive the promised medication. So, United made a formulary exception but required payment as Tier 4 medication (higher than Tier 3).
My 2017 coverage book from United (EOC) clearly says that "formulary exceptions will be charged as a Tier 3 drug". When I told United this, the grievance coordinator said my book says formulary exceptions are a Tier 4 charge (basically calling me a liar). I offered to fax her a copy of my pertinent book pages, but she refused to give me a fax number since she insisted only she knew what my book says. She promised to have her supervisor call me, but that hasn't happened for 3 days now.
Terrible service, many months of effort and United repeatedly refuses to admit and correct their multiple mistakes.