I'm so confused!

[triser72 0]

OK - I am not sure what to do here. Any advice...would be appreciated...I called April 23 to UHC and the Claims rep told me that I was approved for bariatric surgery as of 4:45pm. Yeah! Yippee! Woohoo! So, I called April 30 to find out if a letter had been sent to me regarding the approval. UHC Claims Dept. told me that yes I was approved and my surgery date was May 6 and they were looking at the notification number. But they didn't know why documentation had not been sent to me regarding the approval. WHAT?!?!?!? :confused2:

I didn't even schedule surgery b/c my surg told me that I needed a precertification # in order to schedule a preop appt and surgery date. I asked the Claims rep "Are you expecting me to be in the hospital on this date having this procedure done?" The response was, "Based on our information, you will be." REALLY?!?!?! So, the Claims rep transferred me to Care Coordination for further clarification. Care Coordination said "No, you have not been approved yet. Your file is still under review. We don't work in the same system as Claims." WHAT?!?!?!?! :confused2:

So, I hung up with Care Coordination and called Claims again. Suddenly, they are confused and couldn't find the approval or if any documentation of approval had been sent to me. :wub:

I want to know whose desk my paperwork is sitting on and what that person's direct phone number is at their desk.

Any suggestions...????

[jaria007 2]

I'm just wondering why you are the one doing this? My surgeon's office faxed the paperwork to my insurance and when I was approved, the insurance contacted the surgeon's office directly. That is really strange. I would go see your HR benefits person. That is exactly the point where they should step in

[MyNameIsNatalee 0]

I also have UHC but I never went thru claims. I have a Care Coordinator who has helped me the whole way. I talked directly to her and if any information was needed it was faxed to her. She is the one who told me what I needed to do to get approval and I did. Also, she is the one who sent me my "approval" letter which I got 2 days after she said I was approved. So I would recommend talking to a care coordinator. Good Luck!:wub:

[triser72 0]

I'm just wondering why you are the one doing this? My surgeon's office faxed the paperwork to my insurance and when I was approved, the insurance contacted the surgeon's office directly. That is really strange. I would go see your HR benefits person. That is exactly the point where they should step in

My surgeon faxed the pprwk to insurance. He and his bariatric coordinator advised me "to stay on top" of the progress with the insurance - he said the paperwork often gets lost if someone doesn't call to check up on it. Plus, he said "It's your money that is being paid to the insurance company. You have a right to ask what is happening."

[triser72 0]

I also have UHC but I never went thru claims. I have a Care Coordinator who has helped me the whole way. I talked directly to her and if any information was needed it was faxed to her. She is the one who told me what I needed to do to get approval and I did. Also, she is the one who sent me my "approval" letter which I got 2 days after she said I was approved. So I would recommend talking to a care coordinator. Good Luck!:wub:

I guess a Care Coordinator would help. I'll call tomorrow and ask if one has been assigned to me.

[Elisabethsew 50]

Call and ask to speak to the case worker who has been assigned to you. Get her name and extension and address all concerns to this person only. Welcome and congratulations!

[StLouisGal 1]

I had a similar problem with BCBS. They changed names at the first of the year and lost my paperwork even though I had been told I was approved. It was a pain. I finally had the HR rep from my husband's work (our insurance is through his work) call and I had my approval within about a week of her call. I had my surgery about a month later.

You do have to stay on top of them even though it makes you crazy. By the time I got my approval, everyone in the insurance office knew my name. So far they have paid every bill. Hang in there, you can do this.:thumbup: