UHC - Stalling?????

[Guest Tudge]

I had my initial consult on April 25th where I decided that I want to have the lapband - I went through the dictation process and the paperwork was faxed to UHC on April 29th. I called the insurance company on May 9th to see where the request was in the process and they said they had not received anything.

I called my doctor and the information was re-faxed so I waited another couple of weeks and called back on May 31 - same thing again - the insurance company claims they have not received anything. Again the doctor's office re-faxes the information to the phone number supplied to me by Care Coordination at UHC - and the fax was confirmed... The insurance coordinator at the doctor's office talks with care coordination and they inform her that it can take 15 days from the receipt of the fax before the request is entered in the system.....

So I call again yesterday to see what is going on and the same damn thing again - no record of anything received - again i verified with the insurance coordinator at the doctor's office that the information was faxed and confirmed to the right phone number - the coordinator decided to fax the information again as well as mail a hard copy of the information - so now I have to wait another 15+ business days to even see if I am in the system.....

I am sooooo frustrated - any suggestions?????

T.J.

[mom2mygirlz920 0]

That stinks! Thats the same day I decided I was going to be banded. I was banded May 31! I guess I got lucky~~~!!!!!! Sending some of my luck ur way!!!!!

[okiejudy 0]

Hi TJ. I have UHC too. They kept losing and misrouting my paperwork. I called them last night and they said they denied me because I didn't have any co-morbidity. I guess you have to be half dead before they will approve. I am so frustrated.

[gunn4ya 0]

Yep, UHC seems to misplace stuff a lot. My paper work got sent at the beginning of December but I didnt get any word until the end of January. At least they approved me.

[swarren 0]

You might try asking you benefits administrator at work. If they do not know the answer about whether or not it is included in the plan, ask for a "summary plan description". This is a huge document that lists all of the plans medical/dental/vision and what is covered under each plan. I have UHC POS and it clearly states that weightloss surgery is covered if you are 100 lbs overweight or have a bmi over 40 or 38 or above with co-morbidities.

Hope this helps.

Susan

[sandie1958 0]

tudge; my dr. office faxed paper work to uhc last wed. i got my approval letter on sat,. i had no problem/ sandie

[gordonfamily3 0]

I was just banded Monday June 13th, my insurance is with UHC and I didn't have one problem. Actually I called 3 days after I knew they were sent the paperwork and they had already approved it. I am so sorry you are having problems. No my doctor made me go through a lot of test and even write a letter of my weight loss history. I don't know what all is was sent to them but I was actually surprised at the turn around. There was acutally another co-worker that had by-pass and she was also approved in 3 days. Good Luck!!!

[okiejudy 0]

They said since I was under 40 BMI and I didn't have significant co-morbidity that I did not qualify. I have bad knee and high collesterol but I guess that is not enough.

[TrishS 3]

UHC misplaced my paper work too.. I stayed on the phone with them until i got a straight answer even if i called 10 times that day. I was approved the next day. sometimes you have to fight!!!

[j_war06 0]

I am using UHC also, and I think the doctors are working for them to. The orthopedic surgeon who suggested I see a bariatric surgeon about losing weight told me he would write me a letter back on April 7, he never did, all he and his assistants did was lie to me about him being too busy and taking days off or some stupid mess, anyways I sent a damn good appeal letter to UHC just last Thursday, July 7, what is that 3 months and I am yet to be banded, I hope they come back with a YES! But UHC overall has not helped us out one bit and has been total idiots, where do they find people to work there?!?!

[belle 0]

Hey Tudge,

I am going through hoops too.I have First Health, and they denied me at first.They said it was due to a lack of current docemuntation.What do they want my BMI is over 40, I am pre-diebetic,I take blood pressure medication.It does seem like they want you on your death bed before they will pay.My appeal is up tomorrow, I will have a final answer on whether they will cover or not.I have been sick at my stomach waiting and wondering if they will approve me.

Ill let ya know,Belle

[txbldhnds 0]

A lot of people forget to look into sleep apnea and many overweight people have it. My husband always complained about my snoring, but I didn't think I snored that much. I was congested almost every morning, tho, and ALWAYS woke up with a bad headache. They did a sleep study and I stopped breathing 49 times within 3 hours! Now I use a CPAP machine and feel much better. It was one of the co-morbidities that helped qualify me for the WLS.

Don't forget to include your family history, too. Both of my parents had heart disease, along with 3 of my 4 grandparents. My dad and grandmother were diabetic. That info all counts when drs make decisions regarding qualifying.

Good luck!

Colleen

[Guest meanmom]

I had to fax my paperwork 7 times in 18 days before it was acknowledged. Call UHC, ask for a supervisor, tell them you want to fax your information to them personally and you want them to call you back when they have received it. Also get a direct contact number for them. An call them however many times it takes to get a confirmation that your paperwork was received and is in the system. I called everyday upt to 3-5 times a day until I got my paperwork confirmed as received. I also got the supervisor to put a rush on it since I had gone through the process so many times. Be persistent and firm but remain polite. Once my paperwork was confirmed received and in the system (about 3 days once I followed the above) I was approved 2 days later.

Good luck.

Brenda

[j_war06 0]

Uhc Sucks!

[Amanda S 0]

I had a similar experience with UHC. The first fax was sent in april sometime, I was not as ontop of it at first and did not call till mid june to find out what hte problem was. The claim they never received it... Mean time i had to switch surgeons, i had another office submitt for approval and i called them that day, then the next day to make sure htey got it. They finally said they got it on the 15th and it would take 30 days to process. I still called everyday just to make sure... They called me on the 27th to let me know I had been approved.