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» LymeNet Flash » Questions and Discussion » Medical Questions » Need feedback on United Healthcare PPO

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Author Topic: Need feedback on United Healthcare PPO
Minime
Junior Member
Member # 39163

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I need to know how this health care plan treated people who were in treatment for lyme disease. Did they pay for your meds, your tests, etc?

Also, if you could please indicate whether you worked with in-network or out-of-network LLMD while using this plan.

And also whether it was "Choice Plus" or some other PPO by United Healthcare?

I am considering switching to this plan, so your feedback is highly appreciated!

Posts: 8 | From Chicago | Registered: Oct 2012  |  IP: Logged | Report this post to a Moderator
amk33
LymeNet Contributor
Member # 13206

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When I had the PPO, they paid for blood tests, reimbursed me for a percentage of the LLMD appointment. I do remember them requesting records from my doctor, which was probably around the time that I got the IV (which they paid for).

I believe that it was called Options PPO. I switched to the HMO because a hospital stay was covered at a percentage, which would be a lot of money, if I ever needed it. I also had stopped going to the LLMD, because it wasn't helping me, and I was giving up on lyme treatment.

I was just considering changing back to PPO, but, my original concerns are still valid, and the cost for this plan is more.

Posts: 418 | From NJ | Registered: Sep 2007  |  IP: Logged | Report this post to a Moderator
joysie
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I have PPO. They have been great. Blood work, worked with in and out of network folks, no questions.I'll check the specific plan and let you know.
Posts: 520 | From Maryland | Registered: Jan 2007  |  IP: Logged | Report this post to a Moderator
ESG
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I have Golden Rule Choice Plus, which is really United HealthCare Choice Plus. When I went to an LLMD I had a basic deductible and it didn't matter where I went - once I met the deductible, everything was covered. They did not care about Lyme Disease or anything, LLMD or tests. Everything was covered. But that was then, seven or eight years ago.

Now they have a separate deductible for "out of network" after which they would cover everything - so I basically have 2 deductibles. They still seem to not be choosy re. Lyme Disease, tests, etc.

For prescriptions I use my AAA discount card and not their discount card & they honor that as well, because AAA discount card is actually better than theirs!

They have never balked at a surgery I have needed. Or a prescription or a doctor's visit.

I suppose the state you live in makes a difference, since in CT we have law protecting Lyme Disease patients.

Posts: 424 | From Connecticut, USA | Registered: Nov 2003  |  IP: Logged | Report this post to a Moderator
jlcd1
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I have the regular choice package. It's 1500 max out of pocket for an individual and 3,000 for family.

They paid for 3 months of IV doxy except for maybe $9 a day. They have covered all my scripts so far as well. Except for the co-pays.

My doctor is out of network and they do not reinverse for that. Over all I have been very happy with them.

Posts: 908 | From Albany | Registered: Nov 2008  |  IP: Logged | Report this post to a Moderator
Razzle
Frequent Contributor (1K+ posts)
Member # 30398

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I had UHC coverage through work in 2006. It was terrible! I could never get through on the phone (they changed the phone number and didn't update me), they never paid any claims, and I sent them over $500/month in premiums. Totally worthless policy. I'm so mad I had to sign up for the stupid thing!

--------------------
-Razzle
Lyme IgM IGeneX Pos. 18+++, 23-25+, 30++, 31+, 34++, 39 IND, 83-93 IND; IgG IGeneX Neg. 30+, 39 IND; Mayo/CDC Pos. IgM 23+, 39+; IgG Mayo/CDC Neg. band 41+; Bart. (clinical dx; Fry Labs neg. for all coinfections), sx >30 yrs.

Posts: 4166 | From WA | Registered: Feb 2011  |  IP: Logged | Report this post to a Moderator
Minime
Junior Member
Member # 39163

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Thank you folks for sharing your experience.

Looks like most people had positive exerience, except for that of Razzle (whose "never paid any claims" experience is just plain strange, not even non-Lyme treatment claims?)

jlcd1: "My doctor is out of network and they do not reimburse for that" What do you mean exactly, is it because it is non-Plus PPO? Only in-network doctors are covered, not even lower percentage reimbursement for out of network ones, lyme or no lyme?

ESG: wow, I have not realized some states officially protect LLMDs from prosecution by medical board. But indeed, there is handful of states that does it, I learned from the web.

joysie: thanks for checking

amk33: yes, cost of PPO is way more, I estimated $5-6K more per year than HMO for family coverage based on my employer rates. I recently wrote about it in another thread, and checking on PPO in this one to see if it makes sense to switch or stay put on HMO and pay these $5-6K out of pocket instead. So what have you done with your Lyme since you stopped treatment due to it not helping? Is it in remission now, or been mild enough for you to simply cope with symptoms?

Posts: 8 | From Chicago | Registered: Oct 2012  |  IP: Logged | Report this post to a Moderator
Razzle
Frequent Contributor (1K+ posts)
Member # 30398

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I had this insurance before I even knew I had Lyme, so none of the claims said "Lyme" on them...

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-Razzle
Lyme IgM IGeneX Pos. 18+++, 23-25+, 30++, 31+, 34++, 39 IND, 83-93 IND; IgG IGeneX Neg. 30+, 39 IND; Mayo/CDC Pos. IgM 23+, 39+; IgG Mayo/CDC Neg. band 41+; Bart. (clinical dx; Fry Labs neg. for all coinfections), sx >30 yrs.

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Catgirl
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I wonder this myself. Hubby is looking at another employer who carries united health care. Has anyone else had anymore positive/negative experiences with them? Are they covering parasites meds too?

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--Keep an open mind about everything. Also, remember to visit ACTIVISM (we can change things together).

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Pantsinsocks
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Member # 7440

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I have United Health Choice Plus, and they paid for occasional and short IV therapy a couple years ago, but now, when I had 7mo on 2 expensive IV meds, 2x/day, they balked. I appealed and they the cheif phamacist sent a detailed 4-page letter going on at length about how long term abs are not only unproven but dangerous. It seems their policy related to how hard it is going to hit them financially.
Posts: 67 | From Fredericksburg, VA USA | Registered: Jun 2005  |  IP: Logged | Report this post to a Moderator
   

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