External Review (Uhc)- How Long?

[c945105 14]

Hi,

I was wondering if anyone had done an External Review through UHC? I was denied twice and then they go to a third party external review if you appeal again which I did. I thought it might actually be better to have an outside party review as I did not think UHC was reading my companies policy (the one published to employees) correctly.

UHC received 2/15/12 which they have 30 days but then the external company got it 2/29/12 (not sure why so long) and they send a letter saying they have 45 days.

I called to see if it typically takes that long as Dr. office is pressing for whether going insurance or self pay. UHC did not know and but something in their system to find out (not helpful). I called the external agency and left message but they did not call back.

With UHC my experience has been for other things I had to appeal if it was denied it was quite fast and if it was approved they took their time right to the end to do it. I don't know if that's always the case though.

Anyhow was wondering if anyone else had any experiences. Thanks.

[running_scared 125]

Insurance companies are there to make profits. It is the most profitable to not pay for things, and so they decline. Most people won't appeal anything though, so they get away with not paying for insured benefits.

Good luck.

[c945105 14]

Hi,

The denials were that I didn't meet the policy criteria which is 1) BMI of 40 and 2) Morbidly obese history for five years.

I meet number 1 and they are saying in the denial letters that I don't have "serious" co-morbidities. I am fighting because I do have some co-morbidities (not serious hypertension or apnea or diabetes which they are looking for) but that my company didn't define in #2 to be a BMI of 40 and I've been within 10 pounds for 6 years if not at the 40. So I feel I meet the morbidly obese as quite frankly either they poorly wrote the policy if it meant 40 they should have said that like their first stipulation or I think that they actually left some leniency for people like myself that are not at a 40 just under but have tried very hard to diet medically supervised most of the time. I wasn't over 40 because of all the diet pill popping etc I did but never significant amount of weight came off. So surgery is the last option to get healthy and I definitely will get serious co-morbidities soon if I don't get it.

So anyhow I'm arguing that #2 they are interpreting not to how the policy is written.

Still waiting.. I called them Wed and they did not call back. I need answer hoping before the 45 days as will have to push surgery out as don't want to go forward without knowing for sure. Fingers crossed they will see it my way:)

[NWgirl 574]

if they're only denying you on the second stipulation of their policy, then it sounds as of it's being followed correctly. Morbid obesity is 40+ BMI.

It may be BS, and the only thing you can do is write a supporting letter about family history etc. I have read of people having to track down weight records for 3 or 5 years from the past, and some have a hard time because they did not go to dr's often enough. They do not write their policies to make it easy for people to get approval.

[nursroc 0]

Hi' date='

I was wondering if anyone had done an External Review through UHC? I was denied twice and then they go to a third party external review if you appeal again which I did. I thought it might actually be better to have an outside party review as I did not think UHC was reading my companies policy (the one published to employees) correctly.

UHC received 2/15/12 which they have 30 days but then the external company got it 2/29/12 (not sure why so long) and they send a letter saying they have 45 days.

I called to see if it typically takes that long as Dr. office is pressing for whether going insurance or self pay. UHC did not know and but something in their system to find out (not helpful). I called the external agency and left message but they did not call back.

With UHC my experience has been for other things I had to appeal if it was denied it was quite fast and if it was approved they took their time right to the end to do it. I don't know if that's always the case though.

Anyhow was wondering if anyone else had any experiences. Thanks.[/quote']

UHC?