Question:
Has any body had any trouble out of UnitedHealthcare options PPO Getting OK'D

Isurance changed the 1st would like feedback Thank You    — WANDA T. (posted on January 13, 2001)

January 14, 2001
I have United Healthcare in Illinois and I was approved - BUT only if it's done open. Being a diabetic, I don't want to risk the chance of infection. That was why I selected Dr. Alverdy @ the U of Chicago in the first place. I am gathering information on the web and I've already written ot the Department of Insurance. Now I'll send what I've gathered to the nurse that has denied the procedure because she felt it was "experimental". Good luck, if you have it open, you should be approved.
   — Janelle H.

January 14, 2001
Dear Wanda: I had United HealthCare PPO and found the approval process extremely easy! They told me over the phone what the criteria was...BMI over 40, failed weigh loss attempts, passed psych. eval., BMI could be 35 to 40 with dibilitating comorbs, blah blah. My BMI was 40.9 they approved me over the phone but said it was not official until they recieved (via fax) everything from the doctors office in writing and we received the auth in writing back from United HealthCare. The entire process took 3 days to be completely over with! I can't recommend them enough! Best wishes and much love,
   — Alicia B.

January 14, 2001
Wanda, I was thrilled when my husbands new job offered United Health Care PPO. I had read on the boards here about how how USUALLY is was simple to get approval. This has not been the case for me. It has been 2 months since my paper-work was sent in for approval and were still on hold. The insurance company blames the Employer, the Employer says there is no written exclusions and i fit into the criteria for coverage. United Health Care cannot fit me into a pre-existing condition but are trying very hard it seems to do so. My husband and I have not had insurance for over 2 and a 1/2 years and because of finances i havent been to ANY doctors since our ast coverage with Keiser Permanente (last date of coverage 2-98). Not a GYN-OB...internal medicine...not even a Dentist. United Health asked for a letter from my surgeon saying he had not seen me as a patient prior to our coverage date 11-2000. My doc sent this in and all of a sudden thats not enough. They have now sent INDIVDUAL letters to EVERY doc i saw during my entire time of being a member of Keiser. Thats over 40 Doctors. They are trying to see if i have received any care from these doctors during the 3 months prior to our coverage with UHC. I tried to explain that as a Keiser patient, you can ONLY see Keiser Docs and when you no longer have Keiser as insurance you can no longer seek services from those physicians and surgeons. They didnt listen and now i have to wait for ALL of the responses from Doctors who dont even know who I am. All UHC had to do was to contact the member services dept of Keiser and ask when was the last date i was seen under my benifits. I even tried to write a letter explaining all of this and if they found anything to the contrary i would be held responsible for all expenses incurred. They refuse the letter. I am 30 years old with a BMI of 61. I weigh 376lbs and Im 5ft2inches tall. I have back pain and foot pain. Knee pain when it rains and shortness of breath. I may have sleep apnea. I have panic disorders. I fit easily into the guidelines but they insist on trying to find information that isnt there. I was suppossed to be schedules for surgery in January. THen we were hoping for Febuary. Now its looking like March because of all the responses we have to wait for. They have been hard to work with and even told my Surgeons office not to call anymore because they would get it done as soon as possible and that pressure will not speed them up. Personally i believe it the person that is working this claim and not ALL of UHC.
   — Tracy L.

January 14, 2001
PS....Wanda...my surgeon is a IN-network surgeon for UHC PPO also and he deemed this medically necessary. I will be having an OPEN - RNY...simple cut and dry. This shouldnt be so hard.
   — Tracy L.

January 14, 2001
I have United Health Care PPO and didn't have any problems. The policy states it does not cover the treatment of obesity other than morbid obesity. With a BMI of 43 and several co-morbiditys I qualified easily. Check your benefits book to be sure.
   — georgiacarol

May 9, 2005
I didn't have any trouble getting them to pay for the surgery but god for bid you need a revision. They won't cover it not even for medical reasons. THEY SUCK!!
   — cmva531