Appeal

Well, I have UHC and was denied. I sent in my appeal and was again denied! My problem is that they are saying I need to have specific co-morbidities...which I do! All of this information is in their hands...did they overlook it? Do I send everything again or just fax them a letter asking to look at my documentation again because they already have what they are requesting from me? Getting VERY frustrated!

I am sorry for the multitude of issues you are experiencing with UnitedHealthcare. I would suggest that you check the documentation that you are sending to ensure that everything is written and coded correctly and specifically.  Doing so will also require that you speak with your medical professional to ensure everything is in line on that end.  If there is anything vague, the insurance will use that vagueness as an impetus to return a denial. After ensuring that everything is in line, I would get a mailing address and would mail off all the documentation via certified mail to ensure that all documentation is received.  When dealing with insurance companies, you'll oftentimes find that you'll have to keep detailed records of all contacts (at least, I do) for backup purposes. Other than that, continue to follow up with the insurance company until you get an appropriate answer.  Persistence goes a long way. I hope I was able to assist you.

Xavier -    Thank you for your reply. When my appeal was sent in, I personally mailed it certified AND faxed it also. I just cant understand how they could not clearly see my sleep study documentation showing moderate sleep apnea with CPAP prescribed. Sleep apnea is one of their listed co-morbidities shown on my second denial, they have that in their possession. Dumbfounded?!   In the morning I will call and see if they can re-examine the documentation they have. I will also fax them a letter stating the same.   Wish me LUCK!

MyoMy,            I just wanted to give you a heads up, now I don't have the same insurance co. as you so I am not sure how this rule applies. But when I talked to someone from my ins. co. they told me if my BMI was under 40 I would need the 2 comorbidities. I do have mild to moderate sleep apnea with a setting of 10. I was told that it would have to be so bad the machine would not take care of it. It was worded different but came down to the same thing. Of course my machine does take care of it. I am guessing they figure if you have say high cholesterol and it is taken care of by medications its not really a co morbidity. Just thought I would let you know. I would call the insurance company.                          Renee

Renee - Thanks for your reply. I couldn't believe when I saw the stipulations. Basically it seems that you can be unhealthy as heck, take med's to keep things under control...and your OK? Very CRAZY, as if my health situation will fix itself? Insurance will do anything to keep from putting $$ out. Don't they realize that they have already spent thousands of $$ on all of my Pre-Op testing? Why not approve my surgery and stop paying for all of my medications as I become healthier? Sorry about the rant... just very frustrated!