Nurse Co. Re-assignment with UHC???

[FuriosMommy 3]

Hi everyone! I'm coming to vent a little. My case was first submitted for approval to UHC (Choice Plus PPO) in early November. I was denied (but never received a denial letter in the mail) because I did not have psych eval info or a 6 month diet. The psych eval had just been done and for some reason they hadn't received it yet, and I was told that the diet was not required (by 3 different reps). Just this week 2 different supervised diets were submitted (one while I was pregnant and the other when I was not, both took place in the last 2 years). My doctor thoroughly documented both diets and weights and everything. My psych eval was also re-sent. Now the NCM said she STILL doesn't have the psych eval info and the diet doesn't count because I was PG. #1 there is no exclusion on pregnancy that I'm aware and #2 there was a second diet that clearly took place when I was not pregnant. I'm not sure if she is truly not receiving all of the info or if she's just incompetent. Have any of you had to have your case re-assigned to a different nurse coordinator? At this point I feel like they are just grasping at straws so they don't have to pay for surgery even though I am well qualified. It's frustrating when we pay so much for decent insurance, yet they don't want to cover important procedures. Needless to say I feel very defeated =o( Can anyone shed some light for me? Thanks!

[BeenThereWasThat 2]

YES!!!! My first nurse manager would not return my phone calls and I was having a horrible experience. It was very hard to work my way up the chain to speak to a manager but in doing so I got a new nurse manager who was AWESOME!!!!

[M2G 1,836]

We have UHC and of course everyone's policy is different, but we were specifically told that we need 6 CONSECUTIVE months of "dieting" (weight monitoring) and that if we skipped a month or missed an appt. we would have to start over. I say 'we' because my DH is getting sleeved too, he is just behind me in the approval process. Anyway, we have two different Nurse Managers and two different Case Managers, but they all seem nice, etc. Although his stuff got bounced around a bit this month and he is currently waiting for approval...but it won't matter because the surgeon's last day to perform surgery is today and he has not yet been approved.

I would definitely ask for someone new, follow up with that psych eval...can you get a copy and forward it personally? Just keep fighting, and good luck to you!

[FuriosMommy 3]

Thanks ladies, I think I'll give them a call and try to work up to a manager.

[FuriosMommy 3]

I just had to tell someone.... I called yesterday to get re-assigned, left a voicemail. I got a call back today saying I've been approved!

[MINI-Me 196]

Congratulations!!!

[FuriosMommy 3]

Thanks! I'm so excited.