Any suggestions??....

I was denied on 2/7 for RNY. I have filed an appeal with my primary insurance. I have been calling and keeping up with them. Everytime I call I get the same story... I will send an email to my supervisor about this because nothing has been done yet. It has been way past the 15 day time period they have to respond. Now I am being told it is under clinical review. What the hell are they doing? What do I do at this point? I have an appointment for a seminar in Chicago next Monday but was hoping I would have approval before then to have surgery here. I have IDPA as a secondary and have already decided if UHC isn't going to cover this then I am going to use the IPA. Thanks for letting me vent....I am starting to get really upset with UHC....and yet anxious about having surgery. ~Shelley

Shelly hang in there and trust me IPA is a lot easier to deal with than pvt insurance co's and they might even go after UHC for some of the money in the cost of this.. Dont stress out about it it will all work out but stay on UHC, do they have an exclusion? I would think that considering where you work that if its self managed plan they wouldnt have excluded this?? Get HR involved!!! PICKET RIOT CALL THEN BAD NAMES!!! It will happen just have faith and know IPA WILL pay for it!!! Debby

Thanks for all the support. My office is a self managed plan but they said they are concerned with the surgery being so dangerous and that is why they do not cover it...Yet they have a Dr. that practices this procedure within their facilities????? I have passed the Picketting, Riots... Just went straight for the bad names. I guess I am starting to get a little worried about IPA and not being covered or something crazy. Nothing ever comes easy for me. Maybe that is why I am starting to get a little crazy...just waiting for something to get in the way...like always. Shelley

Shelly, If all else fails you might try threatening to get or actually get a lawyer; that is what my mother and I finally had to do when we were trying to get approved. Sometimes just the threat of involving lawyers can help, it show you are willing to fight. I hope your case doesn't come to that but...I can recommend a really great one...if you like. Feel free to email me for his info. Lisa