UHC Denied Her Medical Claim, But the Office Wouldn’t Let Her Self-Pay

Health insurance will forever be a gray area, mostly because the rules are jumbled and, at times, make absolutely no sense. Just when you think it can’t get any worse, along comes another story proving it can. Case in point is TikTok user @ashepotash’s medical experience. She bravely purchased health insurance (I say bravely because it’s expensive and rarely provides adequate coverage) and tried to use it during a visit to her hematologist.

After the office submitted the claim and UnitedHealthcare denied it, she decided to just pay cash for the treatment, because, well, she wants the care. But she was told she couldn’t do that, because if the health insurer denies the claim, that’s it, she can’t receive the services. Huh? Let’s dig into this wild story, because it simply doesn’t make sense.

So @ashepotash scheduled a visit with her hematologist because she wasn’t feeling well and just wanted to fix the problem and “function” normally. As usual, the doctor’s office submitted a claim to UnitedHealthcare to see what would and wouldn’t be covered, but UHC flat-out denied the treatment.

OK, that’s not unusual, considering insurers often reject medical care if they deem it unnecessary. The operative word in that sentence is they, because now we’re completely at the mercy of insurance companies and what they think is needed. Maybe they should be the ones serving you at the clinic.

So @ashepotash thought, maybe I’ll just get one of the iron infusions the office recommended and pay cash — forget the insurance altogether.

But apparently, it’s not that simple. The office refused to accept her cash for the services the doctor had ordered. She was told she wasn’t “allowed” to self-pay, meaning she couldn’t bypass insurance and pay directly for her visit.

The only “reasonable” explanation she received after speaking with multiple people is that the health group providing the service is contracted with UnitedHealthcare, so if UHC says they won’t cover it, the option to self-pay is off the table.

I know; it makes zero sense. Here’s a woman willing to pay full price for her medical care, and because her insurance denied it, she simply can’t receive it at all.

Mindblowing is the only way to describe this madness. To make matters worse, the office’s only recommendation was that they could “follow her labs closely and wait until I get worse to try again with insurance.” Honestly, at that point, I would have scratched that doctor’s office completely off my list.

Naturally, @ashepotash’s post had folks immediately heading to the comments to suggest loopholes so she could get the care she needs. One person recommended she go to another clinic and avoid mentioning her insurance altogether. But several others pointed out that many healthcare facilities have databases that allow them to confirm whether a patient, or potential patient, is insured.

Another suggested seeing an “out-of-network” hematologist, since then the clinic wouldn’t be “restricted by any contracts.” The downside, of course, is that she would be subject to insurance pricing, which, as many know, is often higher than the cash price for treatments.

The most suggested advice from users was to contact her state’s insurance commission and report both the office and UHC. Denying someone medically necessary care simply because an insurance claim was rejected seems not only unethical but potentially illegal.