Insurance Questions and Answers

I work for United Health Care.  I have been a Senior Appeals Specialist for Pacificare and now United Health Care for 10 years. If you have questions about your benefits, I can probably help you.  If you need me...let me know!  

///busy bee here, never mind me///

bookmarking your id.....

Sure, let me know if you need any help.  Ill be happy to help if I can....

my passion is life is helping newbies. i really did bookmark your id. if you see my blog you will see i am devoted to newbies in every way.

i am keeping your id. forever. ;o)

www.WASaBubbleButt.blogspot.com

would you be willing to be an author on my blog under insurance issues? i know it can be done, i'm just not sure how to add you.

 I have UHC with an exclusion for ANY reconstructive surgery...even if it's medically necessary. Is it even worth appealing?

BTW...I sent you a friend request.

I accepted the friend request, thank you!

And, as far as the surgery, it depends on what kind of reconstructive surgery you are requesting and how it is worded.  if you want to email me here at work, my email is [email protected].  I can look at your plan and see what is going on and what you are requesting OR you can send me the verbiage from your SPD and I can interpret it for you and let you know if it's worth appealing.     Let me know....

Hello,

I have UHC Choice Plus through AT&T and I was denied for RNY because (per the letter) this surgery is not proven for my medical condition.

I have a five year weight history with only one year (2007) being under 40 BMI. It was 35.1.

My comorbidities are:arthritis in my knees, liver damage, stress incontinence, chronic back pain from a stressed fractured pelvic bone, anxiety, depression and breathing difficulties.

I have done a lot of research and I have found studies showing that those who are obese and have these issues are normally helped with weight loss. I have included all of this research in my appeal letter.

Is there anything else I can do? Im afraid that if I don't have the surgery/dont lose a large amount of weight quickly I will develop liver disease.

I will appreciate any advice you can give me.

Thanks!
Chelsea Stark 

Hey Chelsea.  Let me look at your plan.  Can you send me your ID # so that I can look it up and see how it's worded.  Co-Morbidities do sometime come into consideration as long as the verbiage in your certificate of coverage is worded correctly.  email me here at work.  [email protected] will look up your plan and your denial from the pre-service.  I am here at work today, so just email me when you get this message.

Shannon

I'm bookmarking your ID as well, and sending a friend request. We have UHC as well, but one of the best. Liz