Complaint Review: Golden Rule Insurance United Healthcare - Indianapolis Indiana

Golden rule is a division of United Health Care (witch will be on your insurance card) All Insurance companys have an in-network and out of network rate. What is suprising to me is Golden Rule has a very large network.I am suprised you were out of network. I have had Golden Rule for 3 years now and I find them one of the better Health Insurance companies.

I understand your frustrations with health insurance because I see the ins and outs of it everyday. Golden Rule is actually one of the better companies out there when it comes to paying claims -- so let me show you how they work. 1.) Your doctor knows exactly what he gets paid for on a doctor visit. When he signs on to the networ - he agrees to accept the contracted reimbursement rates -- so the whole stupid stuff they are telling you in the doctors office is nonsense. Most of the time this has to do with the nurses working behind the counter. Most of them have no idea what they are talking about, the simply know about copays and that is pretty much it. When it comes to office discounted rates, you are essentially getting the contracted reimbursement rate. Now why can't Golden Rule tell you what that is?? Becuase there are a couple different levels of doctor visits, and also they aren't legally allowed to talk about a claim until it has been filed. My past experiences tell me that United Health Care (your company) contracted rate for a basic doctor visit is about 55 bucks. WHy doesn't the doctor just tell you that??? Because 1.) he doesn't trust the insurance company to make sure he gets his money and 2.) he doesn't trust you to pay if you leave the office. Most doctors b***h about not getting paid on bills by patients. Next problem. THe reason your radiologist are out of network in the hospital is an odd deal. It happens because most radiologist and anasteologists (?) will agree to work in the hospital -- but NOT agree to the hospitals overall contracts. How can they do that?? The aren't enough anasteiologis and radiologist in the country so they have major pull within the health care community. Why don't they just agree to take the in network rate? Because they think it sucks and it isn't high enough. What bothers me about this attitude isn't the fact that they don't want to take the rate, I think they have the right to take charge whatever they want.. What bothers me is that they DON'T tell the patient before they administer services on them that they don't take their insurance. I think it should be illegal. Why don't they tell you?? Because they know you will freak out and not use their services. They want the best of both worlds. They want the patients -- but they don't want to take their insurance. The hospitals put up with this because they need these types of doctors because there aren't very many of them.

I have had that same thing happen numerous times. Go to an in-network hospital, but get a radiologist, anesthesiologist, etc, out of network. Hospital bill goes towards in-network deductible and attending specialist goes towards out of network. If you send an appeal and explain it was part of an in-network claim, it should work out. I have had a few appeals approved and they sent me checks to cover the out of network expenses. Yes, I have Golden Rule/United Healthcare too.