Frustrated with United Healthcare

[copgrrl2009 0]

Ok - So i started this journey 2 months ago. My insurance plan only requires 35 BMI with 2 Comorbilities. They also want 5 years of weight history. I have a BMI of 39, obstructive sleep apnea, acid reflux, hypertension, restless leg syndrome, irritable bowl syndrome, etc etc etc.......... I provided my dr's office with all my records and was told I should have no problem getting approved! We even started my liqued diet. My insurance company told my Dr's office patient meets all needs for surgery. Yay right?? 1 hour from pre-op we find out that I was denied. So, the nightmare begins. First we were told it was because I had to have a BMI of 40 or above and that was the reason for denial. We found out that Clinical services copied and pasted the wrong information over and that was the info they were going off of. Okay, this can be fixed Right? Wrong - my Dr does the PEER to PEER and was again told the same information. At this point I am calling daily trying to get this fixed. Last week, they set up an urgent appeal because i was told that it was their mistake and that it was the quickest and only way to get it fixed. So, I sit for several more days driving myself crazy waiting for the call. yesterday, I recieve a call from the insurance company telling me this time that it was denied because they didnt have enough records for the years 2007 and 2008 and need records from 2006. OMG. I had a hard enough time getting them the records I got them due to everything being switched over electronically and I have no idea who i even saw in 2006 if any Dr so because of that I cant have surgery? I need advice? I dont know where to go from here. HELP!!!

[Khy 16]

Lawyer time?

Khy

[copgrrl2009 0]

UPDATE WITH A HAPPY ENDING!!!!

After 2 denied appeals - A denied peer to peer. Changing Doctors, Stressing my self out to the max........... I get a call out of the blue from UHC last week advising me that they were approving my surgery. WHAT?????? YOUR KIDDING ME??????? I have been trying since June, phone calls daily...........And then, when I least expected it, Bam - I was told that because I was misqouted information numerous times...... They were approving me. Not because of switching Dr's - Not because of sufficient 5 years medical history....... Because they made a mistake. Props to UHC for taking time out to investigate what I had been trying to get accomplished for 3 months. I cant even begin to tell you how happy I am. I know that everything works out for a reason, and maybe this was God's way of havingme switch Dr's. I don't know - But I'm approved!!!!!! And should get surgery date next week!!!!!!!!!

[MeMeMEEE 206]

So glad to hear your happy ending!! Keep us posted on your date and surgery!!

[MaddMama 0]

That's REALLY great! So happy for you! Let us know how everything goes from here!!

[ldydrgnkpr 49]

Fantastic!!!!!! Keep us posted...

Deb

[klus263 9]

Just make sure you have all of this in writing with an approval or precert number. I know from past experience working in the medical insurance area, that it always best to have the document showing approval. Good Luck, the hard work will all be worth it.

[Monica_Lynn 0]

That is great news but I agree with klus263...get something in writing!

[ldydrgnkpr 49]

UHC mails a letter once approval has been determined. I still have mine. (along with the vmail from the case manager. LOL) It usually arrives within two weeks from the day of the verbal.

Deb

[foxgirl74 5]

So glad to hear you were approved!!!

Funny, I have UHC and never received a letter or call from them, everything went completely through my surgeon's office and I later got a statement from UHC informing me they had paid their amount and to be aware I might be billed from the surgeon's for the % they don't cover. Five months later I still have not got anything....oh well, just glad it's done and over with, and paid for!!! Best of luck!!!!

[ldydrgnkpr 49]

Depends on which policy your employer / spouse employer has. I'm covered under state employee policy. Which differs from policy to policy. I have a great policy. When I received the phone call the case manager informed me that a letter would follow. So depending on which policy would dictate what you would receive or not receive. As with anything each is different and experiences will differ as well. I didn't have any issues at all. However, If you can request the approval in writing do so.