Guaranteed Healthcare

After being told on October 22, 2007 that my father had less than a week to live, I made an appointment and visited my primary care physician the next day. She prescribed a mild anti-depressant and a mild anti-anxiety medication. The office visit was, as usual, billed to Mail Handlers Benefit Plan. I paid my co-pay that day, and expected to receive an EOB within a month or so.

On June 6, 2008, I received an EOB from United Healthcare Insurance denying my claim. No explanation, just that they would not pay the claim. Yesterday, I received an invoice from my provider for the office visit. Today, I called Mail Handlers and inquired as to why it wasn't paid. I was told it was because it was a "mental health claim" and they didn't pay those and that I should talk to United Healthcare.

So, I talked to a CSR from United Healthcare. I was told they wouldn't pay the claim because I didn't ask for an approval to see a "mental health care professional" and my physician was not in their "mental health care network". I explained that I'd needed immediate (and temporary) care and my physician provided that. By giving me a prescription that day, she enabled me to stop crying and shaking long enough to spend the next few days with my father (he died on October 27). I offered to send a copy of the Death Certificate to United Healthcare to substantiate my claim of needing immediate care. I was told it wouldn't make any difference.

A thought came to me as I was being told my claim wouldn't be paid. I asked the CSR this: If my husband had a serious accident and I was at the hospital ER with him and requested medication to calm my nerves, would the treatment claim from the ER physician be paid? I was told "No, unless he's in our mental health care network". As I understand it, the only mental healthcare professional who can prescribe medication is a psychiatrist. I highly doubt one could be found treating patients in the ER.

I feel I've been caught in a Catch-22 situation. I am deeply disappointed at the response from Mail Handlers as my husband has been insured with them for 17 years and I for 12 years.