Dragging Out the Big Guns

OK, so after I found out that my surgeon's office had faxed my medical documentation to United Healthcare for the FOURTH time as of yesterday, I went to Human Resources and talked to our rep. She had me sign a privacy release form giving her permission to speak on my behalf in this mess, then she promptly called United Healthcare. Since my company is self-insured through UHC, I think that this will put a fire under them. When she called, we found out two things: 1) The records need to be faxed to the regional office and the customer service rep gave us the direct fax number. I'll be giving that to the surgeon's office today and 2) The only requirement for coverage for gastric bypass is that the patient have a BMI of over 35. Since my BMI is just this side 54, I *know* I'm going to be approved, if they'd only realise that they have my records and make a decision on the predetermination. OY! My advice to anyone with UHC and a self-insured employer: just go ahead and get HR involved from the beginning so you won't end up in the insurance Twilight Zone.

Our employer is self insured and we did try to get HR involved. We ended up hiring Gary Viscio the lawyer anyway.