UHC and a run around, anyone else?

I've been trying to obtain approval from UHC (Choice Plus PPO) for a couple of months now. My patient advocate at my surgeon's says they are faxing items over, and the nurse case manager is saying she isn't receiving it. Is this a common issue with anyone else?

I was denied earlier this month because they did not have my psych eval info or my 6 month diet info. That has been submitted twice so far this week and they are still saying they are not receiving it. Now, they say they have received the diet, but not the psych eval. And they say that the diet doesn't count because I was pregnant. The diet took place a few months after I gave birth, they even have all of those medical records showing that. Is it possible they are causing this run around just so they don't have to pay for the surgery? We certainly pay enough on our insurance premium. It's just becoming a huge frustrating mess. Any suggestions on how to get the ball rolling and get an approval? thanks!

I too had many problems with UHC Choice PLUS.  My problem however was that I didn't have any co-morbidities so they kept denying me.  I finally appealed and won the appeal.  If they deny you due to the pregnancy, I would appeal it and make them show you in writing where it states that you cannot be pregnant at the time of the diet.

Good luck!

Thanks for the imput, I'm glad you won your appeal! I'm trying to see if they can re-assign my NCM... if it's not one thing it's another. She keeps saying she's not receiving everything then she starts questioning stuff. The diet I sent her I wasn't even pregnant during it, she just took it upon herself to assume that. It's so frustrating. She has all my medical records which are from my OB/GYN and it clearly documents when I was pregnant and wasn't. I just feel like if someone is incompetent they shouldn't be in that position. Not to be mean... but it's a huge deal if I get approved or not. It's very frustrating. I'm glad I'm not the only one but it should be this difficult.

Oh yes.... I was done with my classes, labs and evaluations in October. A UHC adjuster first closed my file because they claimed my surgeon's office forgot a page in the fax of my weight history and the adjuster wouldn't wait another business day to get it. Random. So the next day, they had to open a second file for me with the completed paperwork re-sent...........and it took a full month to hear back, only for them to deny. If I had gone off what the generic denial letter said, I would have had no clue why. Thankfully, my surgeon called the UHC medical director to see wtf was going on. It was because they claimed that page on the weight history was still missing. My surgeon corrected them and had someone from the office re-send the same damn thing again and they overturned it. I got my official approval about a week later. They are seriously sketchy on the tracking of paperwork, in my exerience. Also, they made massive errors in billing my pre-op labwork and expensive (covered) tests. I had to correct them a ton of times. Just stay on it, and if you can get your surgeon's office (or better yet, your surgeon) to call them for you, that might get faster reaction.

I'm glad you finally got yours overturned, that's so crazy. That's sort of what was happening to me.... the paperwork had been sent 5 times, but she still didn't have it. I ended up calling and requesting that my case be assigned to a different nurse, I had to leave a voicemail. The next day I got a call saying I was approved. Now I hope the billing stuff isn't a hassle, I certainly do not have any extra cash. I don't have a date yet, but hopefully today. Good luck to you!