Can she help?

After being told on 5 occasions by UHC that I would be covered for this procedure my surgeon's office turned in the claim and it was denied with a written exclusion from my employer. I have contacted benifits and they are talking to UHC about why they told me it was covered. This is the information I got from the person this morning. Do you think this means I may have a chance that they will overturn my case or do you think that she is just trying to teach UHC a lesson for telling me the wrong information? Thanks! The Benifits Representative forwarded your e-mail regarding the misinformation you received from UHC to me. I have asked UHC to investigate why this happened and how, but I will also need to ask you for more information. According to UHC's records, the first call from you regarding coverage was on 5/1/06. (They do admit that you were incorrectly told that the procedure is covered. ) Does this date agree with your own records? Also, they are only showing one claim since May 1, 2006. Do you have copies of other EOB's for services you received after they first told you the service would be covered? Please know that our account management at UHC has been made aware in no uncertain terms that this kind of customer service is unacceptable. They have detected an error in their system, but I realize that it does not help you at this point. Any additional information you can provide in terms of dates, names, costs, etc would be most helpful to us in pursuing this with UHC.

It helps but only if you have been submitting claims related to having gastric bypass surgery. The insurance company may still deny you but it will allow you to seek legal action if they paid medical claims related to you having this surgery and documented by the physician. It's extremely hard to get an insurance company to pay when there is an exclusion written into the policy and it's damaging to mislead an insured to think something is covered and have incurred expenses related to that. Good luck.

I agree wholeheartedly with the above assertion. Some insurance companies (Health Net comes to mind) will actually administratively pay claims if a member is given the wrong information. It seems to me that your liasion may be trying to exercise that option as well. God be with you.