Anyone from Iowa with UnitedHealthCare and fighting
I have passed all their criteria plus some but they denied me saying the hospital wasn't a provider when their insurance clerk says they are. The denial letters reasons for not saying yes didn't make any sense.
The Insurance Clerk told me they are having more and more trouble with UnitedHealthCare even though I meet all their requirements. There is also a form that can be filled out and sent to the UHC to be approved if the facility isn't a provider and even though the insurance clerk swears they are beacuse they have done other's surgeries with the exact same insurance through the same employer is going to go ahead and fill out that form and re-file it and try it that way. The insurance company didn't even send out the letter of denial until I called the doctors office to see if they had heard from them yet and she said NO - I will give them a call and call you back. She returned my call the next day saying they had denied it and sent us the letters but neither of us received them. I finally got mine 2 weeks later but dates several weeks before.
I've asked if there is anything I can do to help out and she said no let me re-file the paperwork and see if I can get them to reverse their decision. It all depends on who you talk to at UHC. I am a Chronic Pain patient due to three failed back surgeries and have a few more things wrong with my back and at my weight I am too high risk for them to help me when that time will come. My neurologist wrote a letter of recomendation for this as well. I have a list of co-morbidities a mile long and my BMI is 42.? I am not suppose to gain anymore than 5 pounds before the surgery and it's tough as I am unable to get very much exercise because of my pain.
I tried to go shopping last weekend to buy some clothes for my 9 year old grandson for whom I am guardian of and was hoping to pick up something nice to wear to an uncle funeral this weekend but after only 30 minutes I could hardly walk and was in so much pain AI could not wait to leave. I didn't get clothes so I won't be able to go to my Uncle's funeral and it will be the first funeral that I had been aware of I have to miss and I've had a lot of loss in the past 10 years between family and friends. I'm sick because I can't be there. I am walking on my treadmill each day several time a day to get in the amount I am suppose to before surgery. I am also suppose to use a BiPaP machine for my pretty bad sleepl apnea but I'm uanble to use it. No matter what type of mask I use I can't sleep with it on. To get the mask tight enough so air doesn't slip out around it and wake me up or cause me not to fall asleep - it's so tight it acutally is painful. I've tried everything they have to offer me. I will be calling again today to see if they have any other sugggetions for me as I'm suppose to be wearing it.
Anyone have any ideas on what I need to do to get this insruance Company UnitedHealthCare to approve this surgery. My surgeon I found is Dr. Glas**** with Sartori Memorial Hospital in Cedar Falls, IA. I have passed my psych eval and all I'm waiting for is the ok from the insurance company so they may run all the tests they want to do before surgery and then the surgery.
You can tell that I am very frustrated as I want to live a better quality of life that I do now by laying around most of the time in bed due to pain and the pain doctors and neurologists all agree as do I that at a much lower weight my pain was not near as bad as it is now. I take quite a dose of morphine daily to just try to help control the pain so it is almost bareable. I have needed an increase in the dose as your body gets use to what you take qand you have to continue increasing as I have since my last back surgery and the day of my disability 5-1-2001 and I have been refusing to increase my pain medicine as I don't live a normal life as it is and on more mg's of pain medication I will just become a total zombie. I need this surgery for me. I want to live a better qualilty of life - I want to be able to go places, shopping and actually take a vacation or something.
If anyone has any advice that may help me I would love to hear it. I am open to anything you have to offer. PLEASE ANYTHING!
The Insurance Clerk told me they are having more and more trouble with UnitedHealthCare even though I meet all their requirements. There is also a form that can be filled out and sent to the UHC to be approved if the facility isn't a provider and even though the insurance clerk swears they are beacuse they have done other's surgeries with the exact same insurance through the same employer is going to go ahead and fill out that form and re-file it and try it that way. The insurance company didn't even send out the letter of denial until I called the doctors office to see if they had heard from them yet and she said NO - I will give them a call and call you back. She returned my call the next day saying they had denied it and sent us the letters but neither of us received them. I finally got mine 2 weeks later but dates several weeks before.
I've asked if there is anything I can do to help out and she said no let me re-file the paperwork and see if I can get them to reverse their decision. It all depends on who you talk to at UHC. I am a Chronic Pain patient due to three failed back surgeries and have a few more things wrong with my back and at my weight I am too high risk for them to help me when that time will come. My neurologist wrote a letter of recomendation for this as well. I have a list of co-morbidities a mile long and my BMI is 42.? I am not suppose to gain anymore than 5 pounds before the surgery and it's tough as I am unable to get very much exercise because of my pain.
I tried to go shopping last weekend to buy some clothes for my 9 year old grandson for whom I am guardian of and was hoping to pick up something nice to wear to an uncle funeral this weekend but after only 30 minutes I could hardly walk and was in so much pain AI could not wait to leave. I didn't get clothes so I won't be able to go to my Uncle's funeral and it will be the first funeral that I had been aware of I have to miss and I've had a lot of loss in the past 10 years between family and friends. I'm sick because I can't be there. I am walking on my treadmill each day several time a day to get in the amount I am suppose to before surgery. I am also suppose to use a BiPaP machine for my pretty bad sleepl apnea but I'm uanble to use it. No matter what type of mask I use I can't sleep with it on. To get the mask tight enough so air doesn't slip out around it and wake me up or cause me not to fall asleep - it's so tight it acutally is painful. I've tried everything they have to offer me. I will be calling again today to see if they have any other sugggetions for me as I'm suppose to be wearing it.
Anyone have any ideas on what I need to do to get this insruance Company UnitedHealthCare to approve this surgery. My surgeon I found is Dr. Glas**** with Sartori Memorial Hospital in Cedar Falls, IA. I have passed my psych eval and all I'm waiting for is the ok from the insurance company so they may run all the tests they want to do before surgery and then the surgery.
You can tell that I am very frustrated as I want to live a better quality of life that I do now by laying around most of the time in bed due to pain and the pain doctors and neurologists all agree as do I that at a much lower weight my pain was not near as bad as it is now. I take quite a dose of morphine daily to just try to help control the pain so it is almost bareable. I have needed an increase in the dose as your body gets use to what you take qand you have to continue increasing as I have since my last back surgery and the day of my disability 5-1-2001 and I have been refusing to increase my pain medicine as I don't live a normal life as it is and on more mg's of pain medication I will just become a total zombie. I need this surgery for me. I want to live a better qualilty of life - I want to be able to go places, shopping and actually take a vacation or something.
If anyone has any advice that may help me I would love to hear it. I am open to anything you have to offer. PLEASE ANYTHING!
Is the facility where you would have the pro cedure a "Bariatric Center of Excellence"?
I have UHC and one of their requirements is that the procedure is done at a "Bariatric Center of Excellemce". This could be why you are getting denied and confusing the insurance clerk.
If I were you I would look for a doctor who does primarly WLS.
I have UHC and one of their requirements is that the procedure is done at a "Bariatric Center of Excellemce". This could be why you are getting denied and confusing the insurance clerk.
If I were you I would look for a doctor who does primarly WLS.
That is all they do. The Doctor is a provider but the Insurance Company is saying the hospital is not a provider. The Doctor's insurance clerk swears that they are a provider since they joined forces with another hospital in the area. I've been hospitalized at the other hospital and if they were out of network I would have ended up with a large bill and didn't receive one bill. This is the web site for my doctor Dr. Glas**** about what they do there for WLS.
http://www.wheatoniowa.org/programs-services/weight-loss-sur gery/default.aspx
My UnitedHealthCare is through John Deere and is also referred to as John Deere Premier. The insurance has changed names so many times we have trouble keeping up, but the coverage stays the same.
I'm looking into a revision from a VBG done in July 1999 to and RNY and when I was trying to get approved for the 1st one I was approved in 4 days.
I have spoken with them before I started this and the insurance company read of the qualifications for them to pay for the revision and I more than meet them. The Doctor’s Insurance clerk has done this for others with this same insurance and says they are getting more and more difficult to work with. She called them to find out I was denied the first time since we hadn't heard a thing from them and they agreed with her that they were a provider and when I called and she called back after getting the denial letter that made No sense we were both told the hospital is not a provider. It all depends on who you talk to and UHC. It's sad to have to go through all this with as sick as I am and this surgery would help me out in so many ways. That is all they do. The Doctor is a provider but the Insruance Company is saying the hsopital is not a provider. The Doctor's insurance cllerk swears that they are a provider since they joined forces with another hospital in the area. I've been hospitalized at the other hospital and if they were out of network I would have ended up with a large bill and didn't receive one bill. This is the web site for my doctor Dr. Glas**** about what they do there for WLS.
http://www.wheatoniowa.org/programs-services/weight-loss-sur gery/default.aspx
My UnitedHealthCare is through John Deere and is also referred to as John Deere Premier. The insurance has changed names so many times we have trouble keeping up, but the coverage stays the same.
I'm needing a revision from a VBG done in July 1999 to and RNY and when I was trying to get approved for the 1st one I was approved in 4 days.
I have spoke with them before I started this and the insurance company read of the qualifications for them to pay for the revision and I more than meet them. The Docotrs Insurance clerk has done this for others with this same insurance and says they are getting more and more difficult to work with. She called them to find out I was denied the first time since we hadn't heeard a thing from them and they agreed with her that they were a provider and when I called and she called back after getting the denial letter that made No sense we were both told the hospital is not a provider. It all depends on who you talk to and UHC. It's sad to hae to go through all this with as sick as I am and this surgery would help me out in so many ways.
http://www.wheatoniowa.org/programs-services/weight-loss-sur gery/default.aspx
My UnitedHealthCare is through John Deere and is also referred to as John Deere Premier. The insurance has changed names so many times we have trouble keeping up, but the coverage stays the same.
I'm looking into a revision from a VBG done in July 1999 to and RNY and when I was trying to get approved for the 1st one I was approved in 4 days.
I have spoken with them before I started this and the insurance company read of the qualifications for them to pay for the revision and I more than meet them. The Doctor’s Insurance clerk has done this for others with this same insurance and says they are getting more and more difficult to work with. She called them to find out I was denied the first time since we hadn't heard a thing from them and they agreed with her that they were a provider and when I called and she called back after getting the denial letter that made No sense we were both told the hospital is not a provider. It all depends on who you talk to and UHC. It's sad to have to go through all this with as sick as I am and this surgery would help me out in so many ways. That is all they do. The Doctor is a provider but the Insruance Company is saying the hsopital is not a provider. The Doctor's insurance cllerk swears that they are a provider since they joined forces with another hospital in the area. I've been hospitalized at the other hospital and if they were out of network I would have ended up with a large bill and didn't receive one bill. This is the web site for my doctor Dr. Glas**** about what they do there for WLS.
http://www.wheatoniowa.org/programs-services/weight-loss-sur gery/default.aspx
My UnitedHealthCare is through John Deere and is also referred to as John Deere Premier. The insurance has changed names so many times we have trouble keeping up, but the coverage stays the same.
I'm needing a revision from a VBG done in July 1999 to and RNY and when I was trying to get approved for the 1st one I was approved in 4 days.
I have spoke with them before I started this and the insurance company read of the qualifications for them to pay for the revision and I more than meet them. The Docotrs Insurance clerk has done this for others with this same insurance and says they are getting more and more difficult to work with. She called them to find out I was denied the first time since we hadn't heeard a thing from them and they agreed with her that they were a provider and when I called and she called back after getting the denial letter that made No sense we were both told the hospital is not a provider. It all depends on who you talk to and UHC. It's sad to hae to go through all this with as sick as I am and this surgery would help me out in so many ways.
Thank you for being my one and only person with any advice. I know my post was long but I was just trying to explain everything so you had a clear picture.
With the help of me calling and complaining and my husband Union getting involved they have finally approved my Revision VBG to RNY with Dr. Glas****
With the help of me calling and complaining and my husband Union getting involved they have finally approved my Revision VBG to RNY with Dr. Glas****
I actually just got off of the phone with United Healthcare and I also have Deere Premier for my coverage. They will not cover Sartori hospital but they do provide coverage as long as it is in network or at university of Iowa. The closest doctor I found to this area is in Fort Dodge and Mason City. I called his office and have my first appointment in 2 weeks! Hopefully you ave gotten some answers by now but I thought this might help!
I am telling you now that they told me the same thing but as I talking with Dr. Glas****'s Insurance ClerK, Kim, she can tell you how to get around it and have your surgery closer to home where it should be done. I had my surgery at Satori with Dr. Glas**** and she got it approved. So if you are still interested in having somewhere closer to your home it can be done. Call Dr. Glas****'s office and ask for Kim and she will explain to you what needs to be done to get you approved to have it done somewhere that is not a provider. I don't know what type of surgery you are wanting but you can go to their page and take a look at what they do http://www.wheatoniowa.org/programs-services/weight-loss-sur gery/about/default.aspx.
I had a more involved surgery as I had a previous VBG done in 1999 so I had a revision from a VBG to an RNY and I had many medical problems and my surgery was tough and lasted close to 5 hours give or take a fewe minutes from what I am told. I was in the hospital 10 days and back to the ER twice with another admision for acute renal failure which means I got very dehydrated because my feeding tube plugged up for the second time. I hope you all the luck in the world but if I had to do it over again I woldn't have changed a thing. I still have my feeding tube in till 9-11-12, at my next appointment and then I will be worried about getting in the liquid and protein after that. I have found a couple items I should never have eaten and will never eat again. I have different forms of the dumping symdrome depending on what I've done wrong and I'm learned fast as it is no fun.
Good Luck!
I had a more involved surgery as I had a previous VBG done in 1999 so I had a revision from a VBG to an RNY and I had many medical problems and my surgery was tough and lasted close to 5 hours give or take a fewe minutes from what I am told. I was in the hospital 10 days and back to the ER twice with another admision for acute renal failure which means I got very dehydrated because my feeding tube plugged up for the second time. I hope you all the luck in the world but if I had to do it over again I woldn't have changed a thing. I still have my feeding tube in till 9-11-12, at my next appointment and then I will be worried about getting in the liquid and protein after that. I have found a couple items I should never have eaten and will never eat again. I have different forms of the dumping symdrome depending on what I've done wrong and I'm learned fast as it is no fun.
Good Luck!
Rowrena Tichy
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