UHC claims I have insurance that doesn’t exist… what should I do?

Claims/Providers Forum
1

It all began in early September when I received a call from my doctor’s office saying my claims were denied because I supposedly had another insurance coverage called Mega Life during the date of my blood work. At first, I thought it might be from my parents or school, but after days of research, I found out I didn’t have that coverage at all during the time they said I did.

They claimed I had it starting last August and that it ended on 08/20/2024. Since my insurance is NJFamilyCare, they said I needed to provide the primary coverage, which UHC insists is Mega Life. There’s a termination date, so it seems Mega Life must have existed. I probably spent over five hours on the phone with them in a month, but still no resolution.

Initially, they gave me a policy number and a phone number, 678-837-1354, but that number was disconnected (you can check it if you want). It led to a place that’s FOR RENT with no business linked to it. After another call, they told me to reach out to my doctor’s office. My doctor’s office confirmed they had the same issue with the same number. After a lot of back and forth, I finally got a helpful associate who tried to figure this out. We called multiple numbers and even spoke to their escalation team, but nothing worked.

After exhausting all options, she said she would send the issue to her superiors, but I haven’t heard anything back (I called her on October 18 and now it’s November 4). When I called again today for an update, I provided them with the reference number from my October 18 call, and they told me to “give the information about the other insurance company (Mega Life) to your doctor’s office so they can send the claim to them.”

I was furious when they said that; it felt like I was just going in circles. So, I filed a grievance today about this issue. I hope it helps, but I’m skeptical. If this isn’t sorted out, I might end up with a bill over $2,000.

What can I do to fix this? I feel stressed and confused about how they got this wrong in the first place.

P.S. I know for sure it didn’t come from college, my parents, work, etc. I’m 20, live in NJ, and I’m a college student who doesn’t work.

3

Do you know if your plan is self-funded? If not, calling your state’s insurance commissioner might help resolve this quickly. If that doesn’t work, your HR department should be able to assist you.

4

Hayden said:
Do you know if your plan is self-funded? If not, calling your state’s insurance commissioner might help resolve this quickly. If that doesn’t work, your HR department should be able to assist you.

Thanks for the advice. I’ll think about reaching out to the commissioner if the grievance doesn’t help.

5

You should call UHC and explain there’s no other coverage, asking them to reprocess the claims.

6

Gray said:
You should call UHC and explain there’s no other coverage, asking them to reprocess the claims.

I’ve done that, but they keep insisting there was other coverage during my blood work date.

7

@Carter
You might need to set up a conference call.

8

I’ve seen this happen where patients don’t know they had coverage through UHC student resources. You should definitely give them a call.

9

You really need to contact your school. Companies have systems that report any other coverage tied to your Social Security number. I know you’re sure, but it’s worth checking out.

10

Wasn’t Mega the old insurance that students could get directly through the school? I remember it caused issues with hospital billing.

11

Ashton said:
Wasn’t Mega the old insurance that students could get directly through the school? I remember it caused issues with hospital billing.

Yes, Mega Life & Health was a company that provided student insurance and was bought by UHC. If your school has insurance with ‘UnitedHealthcare StudentResources’, that might be the reason.

12

There’s some database somewhere that keeps records. They make mistakes all the time. This can be fixed; it just takes a lot of effort.