It's not just what insurance you have, but who the policy holder works for.

[Gardnergirl2 96]

Hi! I just wanted to remind everyone that it depends on your employer. For example, two people can have united health care, but have totally different plans, even if its in the sae state, etc. is your employer self insured? ( they just pay uhc to administer the plan)? That makes a difference.

If your employer provides you with a benefits advocate ( growing in popularity) that person can be very helpful Also, ask your employer ( or spouses if covered through spouse) for a copy ( electronic copy preferably ) of the SPD ( summary plan description) of your particular plan. That way, you can find the requirements yourself and use segments from the SPD should an appeal be necessary. Again, if your employer offers a benefits advocate, they deal with stuff all the time and can be helpful ( I am one for a major US corporation) .

You never know when your denial can be based on something as simple as the wrong CPT code etc.... Or many times, you the insured gets a denial letter bc " additional information needed". Simply contact your insurance company and ask what info? Write down exactly what they say, write down date and time, as well as name of rep spoken with, then call your provider and ask them to resubmit with the exact information required.

Again, if your employer provides someone like me, use them......they deal with insurance all day everyday and its their job to help you.....for me, it's also my pleasure

[BayougirlMrsS 3,935]

Exactly..... perfectly said.

[Cwalband 215]

Very simply put, thanks for the advice! I bet this will be helpful to many!

[Toddy 758]

Perfect example: I had BCBS Tennessee and my insurance paid all but about $1500.

My daughter has BCBS Tennessee, but her policy has an exclusion for WLS so she had no coverage at all.

[Gardnergirl2 96]

Thank you ladies. I just want people to be aware that employers have a summary plan description, and thatis really the " bible" of what's covered