Anyone getting approved procedures through United Health Care Insurance?
I am battling my insurance to get approved for the Lapband procedure. I got the first denial letter when my package was submitted. I wrote a lengthy personal letter about my situation, along with letters from my PCP and my Cardiologist (had a heart attack 5 months ago) stating it was medically necessary for me to have this surgery and receved another denial. I plan on appealing it but they are hiding behind the statement that says, they don't pay for weight loss procedures or programs. However, in my humble opinion, I have a medical condition and they are not providing me the Healthcare I need.
Anyone gone through this please provide how you get approved. I am formulating my letter now along with all the gramarically incorrect things I can think of!!!LOL
Thanks
Anyone gone through this please provide how you get approved. I am formulating my letter now along with all the gramarically incorrect things I can think of!!!LOL
Thanks
Hi,
I had the same type of issue- wls was excluded from the contract my hubby's employer had with the insurance company. I had many issues like you do- and it didn't matter. I waited until we could change insurance companies (to United HC), at the end of the year, but I went ahead and began preparing anyway with the 6 months of PCP visits. Once we switched companies, I thought it would be a smooth road- the UHC has a Bariatric Unit and a resource nurse was assigned to me. However, I still had trouble with the chart notes from my PCP. It wasn't until I re-wrote the notes myself and sent them over to the Dr. and his nurse cut and pasted my stuff to their stationary and faxed it to them- it took three tries with the notes- but now I'm approved.
Hang in there...be persistant and make sure you know exactly what they want and expect from you. I had to attend the seminar, could only use 1 of 3 surgeons in our state, get the psche and nutritional evals and also the famous 6 month chart notes--- when the nurse finally spelled out what she wanted in the notes, though I knew they were way more detailed then my Dr. had kept, though he knew my goal for wls and we had discussed issues, etc., I could fill in his blanks and meet the requirements. Your surgeon's office should be able to help too, they're used to dealing with the insurance companies.
I had the same type of issue- wls was excluded from the contract my hubby's employer had with the insurance company. I had many issues like you do- and it didn't matter. I waited until we could change insurance companies (to United HC), at the end of the year, but I went ahead and began preparing anyway with the 6 months of PCP visits. Once we switched companies, I thought it would be a smooth road- the UHC has a Bariatric Unit and a resource nurse was assigned to me. However, I still had trouble with the chart notes from my PCP. It wasn't until I re-wrote the notes myself and sent them over to the Dr. and his nurse cut and pasted my stuff to their stationary and faxed it to them- it took three tries with the notes- but now I'm approved.
Hang in there...be persistant and make sure you know exactly what they want and expect from you. I had to attend the seminar, could only use 1 of 3 surgeons in our state, get the psche and nutritional evals and also the famous 6 month chart notes--- when the nurse finally spelled out what she wanted in the notes, though I knew they were way more detailed then my Dr. had kept, though he knew my goal for wls and we had discussed issues, etc., I could fill in his blanks and meet the requirements. Your surgeon's office should be able to help too, they're used to dealing with the insurance companies.
Jennlin2697
Hi,
Thanks for the information. I have had all the prelim stuff done. My employer screwed me up with changing insurance companies a couple of years ago, we went from UHC (where I started) to BCBS (emphasis on the BS) now we are back to the UHC last year, hopefully it will stay there. How did you get intouch with UHC's Bariatric Nurse?
Where it is now, my surgeon submitted my package last fall, got the first denial letter in January 09, sent a personal letter and got the second denial, Now, I am getting ready to appeal it again.
Again,
thanks for your info.
Thanks for the information. I have had all the prelim stuff done. My employer screwed me up with changing insurance companies a couple of years ago, we went from UHC (where I started) to BCBS (emphasis on the BS) now we are back to the UHC last year, hopefully it will stay there. How did you get intouch with UHC's Bariatric Nurse?
Where it is now, my surgeon submitted my package last fall, got the first denial letter in January 09, sent a personal letter and got the second denial, Now, I am getting ready to appeal it again.
Again,
thanks for your info.
I had no problem with them in the beginning, my claim was submitted for approval and withing 11 days, I was approved. You may need to involve your HR.
I submitted for a panniculemctomy last year and was denied, so I appealed and was denied again (all in about 30 days total) so I contacted my HR dept and was informed that there was a third appeal that was on an outside review level. Ok, its a shot! Guess what....My RECONSTRUCTIVE surgery was approved in less than 30 days as Medically Necessary! There are reasons for appeals...use them to your advantage! Good Luck to you!!!! :)
I submitted for a panniculemctomy last year and was denied, so I appealed and was denied again (all in about 30 days total) so I contacted my HR dept and was informed that there was a third appeal that was on an outside review level. Ok, its a shot! Guess what....My RECONSTRUCTIVE surgery was approved in less than 30 days as Medically Necessary! There are reasons for appeals...use them to your advantage! Good Luck to you!!!! :)
Kim
On February 20, 2009 at 5:31 PM Pacific Time, jennlin2697 wrote:
Hi,I had the same type of issue- wls was excluded from the contract my hubby's employer had with the insurance company. I had many issues like you do- and it didn't matter. I waited until we could change insurance companies (to United HC), at the end of the year, but I went ahead and began preparing anyway with the 6 months of PCP visits. Once we switched companies, I thought it would be a smooth road- the UHC has a Bariatric Unit and a resource nurse was assigned to me. However, I still had trouble with the chart notes from my PCP. It wasn't until I re-wrote the notes myself and sent them over to the Dr. and his nurse cut and pasted my stuff to their stationary and faxed it to them- it took three tries with the notes- but now I'm approved.
Hang in there...be persistant and make sure you know exactly what they want and expect from you. I had to attend the seminar, could only use 1 of 3 surgeons in our state, get the psche and nutritional evals and also the famous 6 month chart notes--- when the nurse finally spelled out what she wanted in the notes, though I knew they were way more detailed then my Dr. had kept, though he knew my goal for wls and we had discussed issues, etc., I could fill in his blanks and meet the requirements. Your surgeon's office should be able to help too, they're used to dealing with the insurance companies.
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