We have United Healthcare and they are not paying us

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We have United Healthcare and they are not paying us

I have filed a complaint with United Healthcare for non payment of claims which
are fully authorized by them in writing. It has been three months now and it has
been nothing but clerical errors on their part with auth codes, incorrectly
processing claims multiple times, saying they cannot issue a check to me
directly although I clearly have paid the provider in full and have a letter from
the provider saying they will not accept payment. I have filed an official
complaint with them and they say they have 30 days to give me an answer. An
answer to what? They just need to give me my money This is for mental health
benefits through Optum/ which does mental health for them. So far the claims
are so messed up that they can’t even tell when we met our deductible and are
taking their time fixing their errors. In the meantime, we owe on our credit
card. How long should we give them? Since there is no denial we can’t file with
the Dept. of Insurance either.

Asked on May 11, 2016 under Insurance Law, California

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 5 years ago | Contributor

You can sue them for breach of contract: an insurance policy is a contract, and the insurer is obligated to follow its terms and pay out claims when, under the facts and the terms of the policy, they should pay. First, check the policy, to see if it contains (i.e. if you agreed to, in accepting the policy) any limitations on your right to sue, such as limitations on the courts you can sue in, or requiring arbitration. Subject to any limitations in the policy, you could, as stated, sue them for breach of contract, for not following the terms of the policy.


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