UNITED HEALTHCARE HELL ! ! ! !

I have United Healthcare and when Vista Surgical Center called them to get the OK that my insurance covered the surgery, they said that it was covered(that was 5/8/06). NOW I get a call this morning(7/6/06) from UHC saying that the surgery is not covered. What the hell............ now that I have gone and spent over $300 on co-pays and nutritionists that are not covered under my insurance, they are denying me coverage. My surgery date is set for 8/15 and I was sooo excited and now have been completely shot down. I'm really worried that I won't be able to get this "life change" done. I was told by Vista Surgical Center that UHC has done this numerous times before, but I believe I should have been told that and maybe they should get the OK in writing before I go through with all of the doctors visits and get my hopes up about the surgery. Now they have sent the information to The Consumer Advocate to see if I should be covered, which God only knows how long that will take. Does anyone know any way around this? Should I just keep sending in appeals everytime they deny me surgery? I was thinking about getting a loan and just pay on it until all of this with the insurance company is resolved and even going as far as getting a lawyer..................... PLEASE GIVE ME SOME INPUT ! ! ! ! ! Sheri Baton Rouge, LA

Sounds like a typical ply by insurance companies in hopes you will go away. Don't. First, if you spend your own money and try to get it back there is very close to zero chance you will. Insurance companies require pre-cert so don't do this option unless you plan to not get reimbursed. Second, if it is not in writing it didn't happen. I know this is hind sight but get a letter from the insurance company for any denial or approval. I am amazed your health care provider would do anything without having something in writing. Their mistake. I would put presure on your health care provider to take it up the ladder as you did get a verbal. Remember you only have a limited amount of time to appeal but do appeal. But first get the denial in writing so you know what to appeal. Also, if your health care provider said this has been done numberous times before why did they not get it in writing. Also, find out the outcome of these other times and see if they finally got approved and mirrow what they did. Good luck, Jim

Hi Sheri, Sorry you are going through such hell, I feel for you for I'm myself am also playing the waiting game. Have you thought about just purchasing some individual insurance like Aetna or Humana they cover this surgery and you can purchase an individual policy. Hopes this helps. I'll be praying for you.

Thank you all for your information. I'm awaiting the results back from my expedited appeal. Should be within the next few days............... thanks again ! !

Be prepaired insurance companys will keep saying no because they want you to give up. I did my own appeal and they still denied me I hired a lawyer to take care of the state appeal, I should know by next week so hopefully it will work out don't give up hire lawyer it's alot cheaper then paying for the surgery on self pay that's for sure. I takes some time I was denied in May and still no decision yet. The lawyer I used is Gary Viscio he can do out of state as well alot of people use him. Good luck don't give up just need some patience.

Hi Sheri, I am going through the exact same thing with the same insurance company. UHC is not the problem it is actually the employer that opts for the obesity treatment rider to be added or not. I too was told that WLS was a covered benefit under my group health plan, my surgeon's office also called before submitted the pre-cert and they too were told it was covered. I jumped every stupid hoop and got every piece of required documentation and thought I had a solid case - WRONG. I received a denial based on exclusion june 30th. I called UHC that same day and asked AGAIN if it was a covered benefit - SAME answer, YES. I was devistated and have no resolution yet - BUT I have learned a few things since this fight has started. I got an email address of the account exec that takes care of my companies benefits. Until all this crap happened we didn't even have a full certificate of coverage so UHC made a mistake there. I documented who I talked to and when. This account exec started researching my complaint and found that they had a mistake in their system and confirmed I had been mislead. For three weeks she tried to find a resolution for my situation and today I think gave up and emailed me a lovely form letter stating that she was sorry I was given misinformation but adjustable lapband surgery is excluded under my group policy. Well they expect you to roll over and play dead - I have never taken NO for an answer so I went right back at her and said that I was mislead and I appriciate the apology but that does not resolve the problem and requested to be escalated to the next level. I had a short reply from her today, she has escalated it again to her manager and will let me know. On the plus side I have 3 weeks of communications with her in writting admitting that they misinformed me and I was mislead. She eluded several times that she thought they could get an exception for my case. No matter what you do, don't give up. If they give you misinformation, document it and get as much in writing as possible. I don't know if anything will come of this but I tell you I will not give up without a fight. On advice of my surgeon's office I have also submitted a packet to my employer requesting baratric services to be added to our group plan. Again, I don't know what will come of it but it doesn't hurt to try right?

The EXACT same thing happened to me!!!!  Did UHC finally approve you?  I'm in the appeal process right now...furstrating as hell!  Please let me know what the outcome was for you. Julie