Golden Rule

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Arthur of Aiken, SC July 20, 2009

Until recently, my wife and I had a health insurance policy with a subsidiary of United Healthcare, a company which markets itself as ‘Golden Rule’.

The policy lapsed for one month due to nonpayment of premium (one missed payment). We were told to re-apply for insurance with the company, - implying that we could not reinstate the policy, and the reinstatement would be treated as a ‘new application’ (We have been insured with the company for 7 or so years).

My wife has a long term health problem, not life threatening, just an annoyance, called Crest Syndrome, which was excluded from the original policy 7 years ago, and we accepted that fact. On application for reinstatement my wife has been declined, based on the very same condition, having made no claim on the company for the condition at any time.

It seems to us that this is an unfair and unreasonable business practice, given that the condition was excluded in any event at the outset. There have been no other changes since the policy lapsed and we have told the company that in a recorded telephone conversation.

There seems little point in trying to deal with the company directly, given that if this is normal business practice for them, one wonders what twists and turns it might make if confronted.

We can only hope in desperation that someone somewhere in Washington can put an end to these kinds of practices, and although intervention by someone who can deal with this directly would be welcome, - we write this letter in the hope at the very least that the right kind of legislative changes can be enacted, so that others may indeed be more fortunate.

Brian of Bryan, TX March 18, 2009

Previously I had filed a complaint on 3/5/09. I have received a letter in the mail from United Health Care/Golden Rule stating that since my wife is pregnant that they will not be able to reinstate our insurance. It was their biling error in December of 2008 of over 50, 000.00 When I spoke with United Health Care/Golden Rule at the time they told me everthing would be taken care of. After the error was corrected they were to send a certified letter stating how much we currently owed. We never received anything in the mail showing the correction.

They said that they mailed notices to us, but we never received anything in the mail. I find it to convienet that we found out that my wife was pregnant in November 2008 and in December 2008 United Health Care/Golden Rule made a 50,000.00 billing error. Nobody would pay 50,000.00 for one payment. That is why we were waiting to see if the correction was going to taken care of. Now I know that the reason they let it lapse and did not notify us was because they knew that my wife was pregnant, we were paying extra for maternity care. We have proof of their billing error in December. They had no intentions of continuing our policy, their excuse is that they are cutting back due to the economy. If this is not resolved I will be going to the Better Business Bureau, and it will be put in newspapers all over. I have a good friend that would love to here this at CBS and he will be calling me back when he can put it on air.

This is our first baby and my wife & I do not need this stress. I will be spending 20,000.00 on a lawyer to get this resolved. At this point I do not care if they think that I am slandering their name. Everything was fine in 2008 on statements and billing. Why now in 2009 has everything changed...because they knew that my was pregnant. We have tried to talk with the insurance company, but all they tell us is well this is what my computer tells me. Even my agent has tried to talk with them.

Gregory of Parrottsville, TN February 13, 2009

I sustained an injury to my thumb while living in Florida and was treated in the ER. The doctor called in a hand specialist on call at the hospital and she told him what to do and told me to see her in her office the next day to continue treatment. The ER doctor dictated the diagnosis and the medical transcriber assigned a code. The hospital submitted the claim and was paid after I paid a 1,000 deductible.

The problem is the doctor that I saw the next day, who was the one who told the doctor what was wrong and what to do in the ER, sent in a claim to the insurance company with another code. Both codes were similar, but made it sound like I had two separate injuries. I sent paperwork which shows it was the same exact thumb and the same injury and also tried hard to have either the hospital send a corrected code or the doctor change the code, but neither would.

Now the insurance company wants another deductible paid in order for the doctor to be paid since because of the two codes the insurance company sees it as two separate injuries. I sent a number of documents that showed it was obviously the same injury and yet the person I listed above sent a letter saying again it looked like two separate injuries. As stated in this newest letter...medical plan you had with us included a per condition deductible....the maximum plan benefits have been paid. In other words, they still view it as two separate injuries.

The fact that the insurance company can use a small technicality to get away with paying a claim doesn't seem ethical. The time and expense incurred trying to deal with this situation is insane and dealing with one person after another who refuses to see the facts. This whole experience has made my wife an emotional wreck and is just another example of insurance company fraud. Saying they will pay for health care and then finding a loophole to not have to pay.

Why are we having to deal with other people's mistakes and having to come up with additional money when the deductible was already met? It may not seem like a big deal, but if they did this to us, how many other people has this happened to? One other thing, how can hospitals or doctors get away with dictating incorrect diagnoses? After filing a complaint about it and asking that it be corrected, the hospital refused. Florida Hospital-Adventist Healthcare, Winter Park, FL

Jeanne of Henderson, NV December 10, 2008

Golden Rule denied me health insurance coverage citing a condition that I have never been diagnose with and was corroborated by my doctor. They also withdrew the premium out of our bank account without covering us and stated it was 'standard'. We decided to get our own health insurance, as opposed to opting for Cobra with my previous employer, until I am elegible for the benefits with the new company.

They are holding money that belongs to us and we arent even covered.

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