New Lawsuit Alleges Unitedhealth/Pacificare Deceived Cancer Patient

If you have a good case, you try it in court, not in the media. Press releases from law firms generally indicate a strategy of trying to get the defendant to settle to avoid bad publicity, not a desire to litigate a strong case on the merits.

As if that wasn’t enough, PacifiCare refused to pay the bills for my kidney surgery by the experts at the Cleveland Clinic because it was not in the company’s network. PacifiCare didn’t tell me that it wouldn’t cover the surgery until the day before the operation, waiting until after I had already traveled across the country, and contradicting the recommendation of my in network doctor.

The fact that they were slow to notify you of the coverage decision doesn't speak well for how well Pacificare is run, but it isn't surprising that they refused to cover something that was out of network, and it hardly sounds illegal. How far in advance had you asked them if they would cover the surgery?

As for canceling your policy, Pacificare certainly had no way of knowing that you tried to apply in early January (the fact that you talked with your agent about it in November is not relevant). As far as they knew, you applied after January 20 (when they finally got the forms), when you already knew from your scan that there were some problems. It may be your agent's fault that the forms were not in by early January, since he gave you the wrong ones, but I really don't know if Pacificare has a legal obligation to grant you coverage unless you can prove that you didn't know you had cancer until after your final application was submitted. Did you explain the application situation to them after you found out they were canceling?

United Health was really good on it's own. Pacificare was always terrible.

Good luck my friend.

I'm now with Blue Shield.

Why aren't they allowed to raise premiums?

UHC is under investigation by SEC for post dating all those big stock options..while our premiums continue to rise.
I had cancer surgery under UHC coverage and they wouldn't pay for all the post op slide work. I had to pay for that.
They really didn't want more info to make the treatment more effective or targeted. I am lucky..survived three years now and almost out of the woods.
UHC is generally slow pay and looses the first claim.
So Dr. charge them higher rates in their contracts.
See Wall Street article on their problems..they need to restate earnings.

Thank you for posting this.

Good luck with your case against United. I hope you prevail against them, as they seem to have a reputation for being dirty and should be held accountable.

Similar to companies paying huge CEO wages yet they file bankruptcy and squirm or deny promised benefits to employees/retirees who dedicated their service to them.

If you can't work like you use to you should file for Social Security Disability. After two years on that you will also be covered by medicare. Most people who file for disability can also go on their states medicaid program until their disability is approved.

Wow! That's some story. I'm glad that your tumor was discovered so early. Our health-care system is in miserable shape and billions are being made by screwing it up more.

It doesn't sound like there is an easy fix for your problem. I hope that your attorney is competent. I think that you should take a closer look at including the medical group in your litigation. It sounds like they really dropped the ball.

Most important, don't let the fight consume you, you need your strength. I don't imagine that you will get many replies to this post as a Trula substantive reply requires more facts. It might be worth contacting the hospital where the surgery was performed to see if there is any grant money or other assistance available. An irony of the way hospitals work is that the private pay patient gets to pay almost twice as much as an insurance company would pay for the same service.

Good luck!

unfortunately Health plans in Cal can cancel you if you have individual insurance, I have never worked for pacificare but have heard nothing but bad things about them.

good luck with the suite, I's go after the Dr too

Trula = truly. Damn spell checker. What's a Trula anyway?

This seemed odd since I won’t be eligible for Medicare until the year 2037. Since I signed up for coverage with Pacificare, I have also received an AARP card and a letter from Liberty telling me how they can deliver my Medicare drugs right to my home. Why they think I am eligible for Medicare is beyond me.

When you insure with Pacificare, be prepared to spend a large chunk of your life trying to get them to fix bonehead errors. From my perspective, the company is entirely staffed by tree sloths.

Thanks for posting this. I am sorry to hear about your situation and will keep you in my prayers.

I have been posting frequently in the last months about McQuire, the CEO of UHC United Healthcare who just announced his abrupt retirement, and many other administrators that seem to think their purpose in life is to skim from a health insurance pool and overpay themselves.

By the way, McQuire's stock options are $1.8 billion and they were backdated. His annual salary was $219 million.

In all things of capitalism I have never been bothered by someone earning as much as the capacity of a free market could allow, but healthcare is not one of them.

First healthcare is not a free market, it is a regulated captive market. Second, healthcare has a large government involvement, meaning that alot of the revenue stream is originating from taxpayers. Third, the way to grow a healthcare insurance business in which all such insurers find themselves in a saturated market is to acquire other insurance companies.

One way to get capital to acquire such other companies is to sell (dilute) stock and promise accretive earnings. But to get such an accretive position means a tradeoff between the amount of dilution and the merged financials of the acquirer and the acquiree. That translates to pressure to get the stock price up. But markets will normally drive a stock's shareprice up only in response to an increase in earnings. That further translates to cutting costs, expenses, increasing the time of the float and so on.

In the insurance business it is simply a matter of denying and delaying coverage to premium payers, or getting rid of the high risk insureds, which appears to be what happened to you.

This is what irritates myself and others to no end, to see patients get the shaft because such crooks as McQuire want to pig out at the healthcare trough.

UHC and others have been consolidating their businesses through acquistion and they have institutionalized a policy of deny deny deny and otherwise delay in order to get their financials in order to make those aquisitions.

My wife, a physician, says UHC is the worst. She spends far too much time on the phone in her clinic fighting to get coverage approval from them for her patients. Her time could be used so much better by not having to deal with UHC and others like them.

UHC is but a sympton of a larger problem. The solution for doctors is to go with something like 'retainer fee medicine'; Google it to get an idea what it is.

Just so we can all be informed, the way employers got involved in health insurance started in WWII when wages were frozen. Employers offered non wage benefits as part of compensation, usually pension plans and company stock. Some employers started to offer paid visits to doctors as well.

The long and short of today's healthcare problem is there are too many hands in the pie, too many middlemen. The system is very inefficient. All that is needed is for a patient to pay their doctor or the medical group they contract with.

The idea of insurance is if you and I pay on the average $500 a month (our employer pays it for us as part of our compensation package) then if I need $1000 of medical services this month then you and others are going to pick up the extra for me. And conversely, if you need a $1000 of services next month then I and others will pick up your end.

But it's not $1000 in services even if the doctor and the doctor's staff say that is what it costs, it's $2000 because the 'administrators' and their staff got their hands in the pie. So they get in the business of driving up costs and at the same time claim they are managing costs. It's a scam.

Congrats on getting some lawyers to take your case. I hope they sue UHC out of existence. I will gladly short their stock. Their stockholders deserve the same fate as Enron if they can't see the cesspool of corruption they've bought into.

And good luck on fighting your cancer. There's great hope today for alot of cancer patients.

Lastly, make sure it's Ok from your lawyers to communicate information on this forum. They might have a better chance if you remain mum.

thanks for filling in the blanks.

It seems strange the UHC isn't cross-suing for fraud, since they accused you of it.

It seems strange that they haven't asked for a refund of all benefits paid, if, as they contend, you shouldn't have been covered in the first place.

It would seem to me UHC will turn this into a simple contracts case, with maybe a matter of agency thrown in.
to be determined is, is the broker considered an agent of UHC ? If so, UHC is probably in a trick bag.

The policy probably has some weasel words\houdini clauses that UHC will rely on.

IMHO, UHC doesn't need the additional grief and should settle this out.

good luck to you and your attorneys.

As someone who has had to go through this, I have a duty to warn others. I asked for the press release so that other cancer patients are aware of my situation. I could not live with myself if someone died from their cancer spreading because their doctor left positive margins and told them to wait and see.

The problem lies with both the doctors, and with the insurance companies. I put most of the blame on the insurance company because it is their pay methods that cause the doctors to behave in such a manner. Doctors jave been fired for spending too much money for the care of their patients, not by the insurance company, but by other doctors who are in charge of the Medical Group. It is called Capitation.

Capitation is a fixed amount of money per patient per unit of time paid in advance to the physician for the delivery of health care services. The actual amount of money paid is determined by the ranges of services that are provided, the number of patients involved, and the period of time during which the services are provided. Capitation rates are developed using local costs and average utilization of services and therefore can vary from one region of the country to another. In many plans, a risk pool is established as a percentage of the capitation payment. Money in this risk pool is withheld from the physician until the end of the fiscal year. If the health plan does well financially, the money is paid to the physician; if the health plan does poorly, the money is kept to pay the deficit expenses.

SBD

In all things of capitalism I have never been bothered by someone earning as much as the capacity of a free market could allow, but healthcare is not one of them.

That's a risky thing to advocate, because if the earning potential in healthcare is limited to below the level of other industries, the healthcare industry--one of our fastest-growing, most complicated, and most important--will lose many of the best executives and innivators to other industries, potentially with significant long-term costs.

A press release from the Law Offices of Robert K. Scott? Forgive me if I withhold judgment on UnitedHealth.

Try not to be so skeptical. There are plenty of terrible doctors out there. Unfortunately the insurance companies are even worse. I have had a couple of hideous experiences for both myself and my husband. Unless you have been seriously ill and cheated by an insurance company or health care provider you can't really know how awful it is. The penalty against insurance fraud should be absolutely financially prohibitive, otherwise the big companies will just keep on cheating.

Some of the healthcare providers are just as bad. After months of trying on my own to get justice, I finally had a Consumer Reporter with a local TV station help me. The insurance company wouldn't budge; but, the healthcare provider finally came to their senses. Sick people should not be put through this hassle just for trying to stay alive.

Oh, I wasn't assuming the claim was meritless; I just didn't want to make a decision based only on the story told by the lawyer on one side. From the later comments, it really just sounds like a difficult-to-resolve contract dispute that I couldn't judge without knowing all the laws and relevant facts.

How much does a full body scan cost?