united healthcare denial

courtney · January 4, 2007

i was wanting to know if there is anyone out there that has been denied through united healthcare but their appeals were successfull? back in november when calling to find out my benifits 3 different times i talked to different people ( with united healthcare), they said lap band was covered as long as i had a predetermination letter. when i went to see the doctor, he said i was a perfect candidate for the lap band. when i talked to the insurance coordinator for the doctor, she said that since they said that and united healthcare was so good about approving it, she said i have 100% chance of getting it. we just had to wait for the final approval letter before we could start the process. well 3 week later i recieved a letter stating that i was denied because it was an exclusion in our policy. i was really upset. of course we appealed it and now just waiting. is there anyone out there has delt with the same thing? how did it work out? i guess im just trying to see if i should get my hopes up or what. it is like a emotional rollercoaster everyday wondering, am i going to get my life back, or am i going to miserable for the rest of my life. i cannot afford this surgery without insurance help.

TracyinKS · January 5, 2007

I don't have UHC, but I wanted to give you some encouragement...

APPEALS work, just look at all the people on here who have appealed and won!

ousooner · January 5, 2007

This might be dificult, but not impossible. This is not a UHC issue. Your employor who the the policy is through has excluded lap-band as a way to save money for the company. They probably got a better deal by excluding certain things from their coverage.

conniesueb · January 5, 2007

Wow-that sucks. I have United HealthCare, but They approved my request. Although, I had to pre-pay for my surgery, and am now waiting for re-imbursement, but they did say that the procedure would be covered. So, now I am just waiting. They told me when I first called that if they did approve it, it would be covered at 90%, so I am really hoping that is the case. I am also a little worried about them paying for the anesthesia, and the surgery center along with the actual doctor. If they don't, I am going to be very upset, and appealing right along with you! Don't give up though--maybe your doctor's office could help you with your appeal--they know the right terminology to use. Good luck with everything!

avilla · January 6, 2007

I have UHC and never had a problem with them covering my surgery the first time it was sent to them for approval..My dr did say that for an approval without a medical problem your BMI would have to be 40 or above..The only thing that I had to pay out of pocket was my regular copay..But I do believe that the company that you work for can actually exclude certain things from the policy when they sign up for it..I say fight it and appeal it till you cant any longer!!