Denied, Help with Appeal

I received a denial today for my panni and thing lift from my insurance company UHC.  I don't believe my pcp letter was enough. Although, i had been seeing him for the sick boils etc. If anyone has info about appeals please let me know. Any help would be greatly appreciated. I am very discouraged right now. I can't afford the surgery.

thanks

what was the basis of the denial?  what is the criteria for approval under your plan?  Did your PS submit anything?  Did anyone send in photos?

the denial stated it was cosmetic. Not enough info to be considered reconstructive. My ps sent info with pictures and ltr from my pcp noting rashes and treatment.  I am not sure what else they want. I am going to request more info from them before doing the appeal. Any info would be great.

 

thanks

I'm waiting for my answer for my panni and breast  lift. I also have UHC. Now after seeing your post I'm very worried. I also have bad rashes.I also had really good letters from my pcp and plastic surgeon, It's been 4 weeks and to me that means bad news. I guess if this fails looks like Mexico for me.............Good Luck,,,,,,,,,,Paula

don't worry, prayfully everything will work out for u. I don't think my pcp wrote a very good letter because he was not really helpful with this process. I am going to appeal and hopeful everything will work out fine.  It took 3 weeks for my denial so u might get a yes.

 

 

iF YOU APPEAL, PLEASE LET ME KNOW WHAT HAPPENS. I WAS DENIED ABOUT A YEAR AGO . iIDIDN'T FIGHT IT THOUGH. THEN I DECIDED TO TRY AGAIN THIS YEAR. I DON'T THINK UHC IS VERY GOOD WHEN IT COMES TO PLASTICS..............PAULA

I will surely let u know.  i had aetna until this year, and they were a lot better at approving things for me. Plus they have there coverage policy bulletins where u can look at what is needed for approval. U don't have to play the guessing game.  I am praying for the best.

How many doctor's letter did u send? I am going to get one from my chiro, gyn and bypass surgeron this time to send along with the appeal. I don't know what else to do.

 

 I sent 2 letters. One from my pcp and one from the plastic surgeon.Its been 3weeks and I called UHC today and they haven't got al the paper work yet from the plastic surgeon. I'm going to call the plastic surgeon tomorrow to see what the hold up is. I hear so many different things about UHC. Some people get approved while others with the same problems don't. I don't get it.....Hope all goes well wit you.....Paula

DOnt get discouraged just yet!  THere are processes that you can follow that are there for you.  THe Appeal process goes to 3 levels with UHC!  My first was denied with the letter by my PS...I then wrote a letter myself and it was denied.  I wrote a letter to my husbands HR and they informed me that there was a 3rd level appeal that was reviewed by PS's outside of UHC.  I just sent the same letter as my 2nd appeal and the same exact pics that my hubby took of my issues.  Good luck to you!

thanks for the info, I am going to appeal and fight for this. I do feel it necessary. I am going to get more info from the doctors and have a appeal sent. I am going to wait a few months for more medical info and resubmit.  thanks for the 3 appeal info. I didn't know about that.