This is a story about how the little people rose up against an insurance company – and won!
Here’s what happened:
My Star-Telegram editor, Lois Norder, devised an idea to poll our readers. We offered them several Watchdog column tips and asked them which story they wanted Watchdog Nation to pursue. You can see the original poll story in this Dave Lieber column. This turned out to be a remarkable way to test the pulse of our readers. It’s the first time in more than 30 years on newspapers that I was able to get this kind of data.
The winner, by far, was a story tip about a retired couple who couldn’t get anyone to care about how United Healthcare was ignoring their pleas for insurance coverage.
Well, the people who took part in the poll cared. And when we alerted United Healthcare that our readers were on to them, the matter was quickly settled.
This problem could have been solved three years ago! Really, it’s unforgiveable. The end results, which first appeared in this Dave Lieber Watchdog column on September 13, 2009, are also below:
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Today we look at the wonderful concept of taking ownership of someone’s problem and solving it. Does anyone do that anymore?
Certainly, in the case of Joaquin and Martha Romero of Arlington, nobody did.
Not the human resources department at American Airlines, where Joaquin Romero had retired as a ground crew chief after 30 years.
Not UnitedHealthcare, which improperly rejected his claims for the past three years and kept telling him to contact an insurance company that most likely does not exist.
The only people who took ownership of the Romeros’ problem were Watchdog readers who voted in a poll I held last month to pick their favorite story among 10 suggested topics.
You did what nobody else would do: You cared about their problem and made it priority one.
Too bad nobody cared before now, because their issues could have been resolved three years ago. But that didn’t happen.
When Joaquin Romero retired, he expected that the health insurance offered under his union contract would provide supplemental coverage for expenses not paid by Medicare for him and his wife for the rest of their lives.
But when the couple filed claims with United for the allowed 20 percent unpaid cost, they were always rejected.
“Denial after denial after denial after denial,” Martha Romero says. “It’s unbelievable. It’s the biggest problem I’ve ever had.”
The reason? United kept telling the Romeros that their secondary insurance was handled by another company, Intercare.
The Romeros could never figure out what Intercare was. I couldn’t find Intercare either.
But try telling that to United’s computer system, which kept reporting incorrect information. Nobody bothered to change it.
“I’m at my wits’ end here,” Joaquin Romero told me.
Once we shared the information with American Airlines and United, the insurer found the problem in its system.
The company is now reviewing records and expects to pay the Romeros about three years’ worth of rejected claims. It could total several thousand dollars.
United says the company believes that the phantom insurance company’s listing was based on information provided by one of the Romeros’ doctors. The Romeros say their doctors checked all records and could never find the mistake.
Martha Romero says she refused to quit fighting because she knew she was right. But that’s rare.
Jim Riddlesperger, a political science professor at Texas Christian University, says most consumers don’t fight rejected claims very long. A company can delay making payments, as happened in this case.
“So, obviously, denying claims as a corporate strategy is a way to save money,” Riddlesperger says.
Unanswered questions remain, though, about the various people who could have helped the Romeros but didn’t.
Take the human resources representatives at American.
“When I called, they didn’t want to go into the details,” Joaquin Romero says. “I asked a young lady, ‘Why don’t you get ahold of “?UnitedHealthcare?’ She said, ‘No, you have to do that yourself.’
His reply: “I already did, and they sent me back to you.”
American spokesman Tim Smith said call center representatives saw that United was listed in records and sent the Romeros there for help.
When I pressed Smith for how American retirees should handle similar problems, he suggested writing a letter to the airline “to a different set of people” for help.
He didn’t specify who. (So send it to me at watchdog@star-telegram.com).
And what about Olive H.? That’s how the “appeals coordinator” who rejected the Romeros’ claim signed her letter.
Olive H. wrote: “I reviewed your concern and found that no corrective steps can be taken at this time. I made this decision because the United Healthcare system is showing a plan you have coverage with Intercare.”
So much for that thorough look.
Kim Whitaker, a United spokeswoman, acknowledges that Olive H. “didn’t look further and dig deeper.” Customer service reps will receive additional training to learn to do so, she said.
“Certainly, we apologize. There was definitely a mistake made here.”
Martha Romero is grateful to readers who voted for their problem.
“I can’t thank them enough. Our backs were so up against the wall. I didn’t know who else to go to.”
News researcher Cathy Belcher contributed to this report.
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What to do when a retiree’s secondary insurance claim is rejected
Ask the insurance company to explain the appeals process.
Seek help from the company where you retired.
If the benefit is part of a union-negotiated contract, contact the union for help.
Complain to your state’s Department of Insurance.
Consider suing, allowed under the federal Employee Retirement Income Security Act.
