State of Az-UHC Revisions

Hi All, I contacted UHC and I can't seem to get out of them the criteria for revision surgery.  Does anyone have any information on this?  All I get is that it is excludes except for medical necessity.  We all know that people are getting approved for initial surgery and they paid for mine in 2004.  I am just if anyone has gotten this information out of them.  They tell you to look at the policy book, but it tells you nothing but excluded etc. Thanks,

I wish I had an answer for you! I, too, am State of AZ, UHC.  They are horrible to work with, aren't they? After years, I was approved, had my surgery on 8/14/07, and they still insist I'm not covered and haven't paid Dr. B,(although they paid the anesthesia and hospital). I filed a formal appeal that they ignored for a month, and is now being processed. When you call, ask for Rapid Resolution. It's not rapid, and they don't particularly resolve anything, but your request will be in the records.  I always start my calls by asking, "Is this call being recorded?" and when they say yes, I say, "Good!" Has your doctor filed a request for pre-authorization? If not, maybe that's where you should start. At least if they deny your request, they have to tell you on what grounds.  And then you can appeal, formally. It's amazing that there is no DOA liaison or advocate for us, isn't it? I am so tired of battling with them - but I think that's their strategy. Let me know how it goes. Maxine

I haven't done anything.  I had called them to ask if revision surgery was covered and they said that surgeries are excluded.  We both know they are getting approved for 1st surgeries.  I saw the GI Dr. yesterday, he is doing an EGD and Colonoscopy for my constant pain the in stomach.  I have to wait 3 weeks for the tests to be done, I had to wait 3 weeks to see him.  If the EGD or Colonoscopy doesn't show anything, then he will order a CAT Scan.  I am hoping we can figure this out.  I know Dr. B doesn't want to really deal with me, so I probably will be seeking revision from Dr. Schlesinger. Don't give up the fight.  Do you have a copy of the approval letter?  If you do it should be paid, no questions asked.