Question:
Has anyone been denied by United Healthcare?
my doctor orig. filed with CIGNA HMO in June and they denied because they needed more info, then July 1st our insurance co was switched so my doc refiled with United Healthcare and they denied because it is not a covered procedure, even if medically necessary. — Rhonda S. (posted on July 14, 2000)
July 14, 2000
I was approve by UnitedHealthCare and my surgery is schudale for July 26,
2000, however I had another doctor check into it and they told him it wasnt
covered....and I know of another lady with our insurance has already had
the surgery and they paid for it.....if you go to your PCP first then have
them refer you it gets approve alot easier let them get the referral
approve first ........
— patrioticwife
July 14, 2000
I have United Health Care of NC. This week after waiting over 4 weeks and
many phone calls to them they now tell me that my request was sent back to
the customer service area due to the exclusion clause. They said this was
not a denial because they did not even consider it. I was told I have the
right to appeal but it is not a covered benefit. There are many out there
that have UNC but it depends on the type of plan you have.
I do plan to appeal.
— Glenda E.
July 14, 2000
I have United Healthcare Choice HMO in Maryland, and although my experience
has been very limited so far, I must admit it's been somewhat discouraging.
Depending on who you speak with at customer service, you are told
everything from UHC not covering the surgery no matter what the
circumstance to them covering it, but only under the most severe. I've
made it a point to call them at least four times to see if the answer is
the same. I've realized that although it can be a covered procedure under
the right circumstances, you pratically have to "pry" the info
from them to get a truthful answer. Be persistent, ask tons of questions,
and hang in there!
— Kimberly D.
July 15, 2000
I have united health care select hmo and had the surgery in april 12, 2000.
It might depend on option your employer said they would pay for. Most
everyone on this sight that had united health care has been approved from
what i read.
— Sharon T.
July 15, 2000
I have United HealthCare POS and had the WLS done on March 22, 2000. My
surgeon submitted the request and was approved within about 2 weeks. Don't
give up!
— Jonna B.
July 29, 2000
my doctor's office said taht they sent my clinicals to uhc on 6-9-00. after
a month and ahalf of waiting i started to call them almost everyday to see
if they had it yet. finnaly i was able to tt tanya a customer advocate with
uhc. she gave me a fax # that my doc could fax the clinicals to.i thought
that everything would be great from there but then toe paperwork was sent
to the wrong office. well as of yesterday i tt linda a nurse who is
reviewing my case for approval, and she has everything nad said she will
call my doc as soon a a decision was made. i don't blame the insurance
company for the hold up. i just wish that everyone could be on the same
page. the people i've tt at united health have been extreamly friendly nad
courtous.
— shannon P.
July 29, 2000
I have UnitedHealthcare POS and had surgery May 1. I was approved in 2
days. Do you have an exclusion in the policy? If so, talk to your HR
department. UHC puts into the policy whatever your employer wants them to
cover. Good luck!
— Maxine E.
August 12, 2000
Approval depends entirely on whether your specific policy has a written
exclusion. Mine does. In two appeals, the committee has basically agreed
that my doctor makes a good case for the medical necessity, but that it
cannot be covered because it is a specific exclusion. I am looking at
whether to take it up with my employer or look at legal action or what, as
I have absolutely no resources (like home equity) to pay for it myself
without insurance help.
— Mary Ann M.
February 19, 2001
I am in your situation right now. They approve open but not lap, which Dr.
Alverdy refuses to do (in my case). I have sent studies dating back from
1993, the doctor has written letters, they will not budge. I filed a
complaint with the Department of Insurance and wrote letters to my
congressman. Getting government officials involved will carry more weight
(as the Dept of Ins advised). UHC has asked for an extension until 2-22-01.
My advise is to use more than your insurance booklet. Have your company
send you the "certificate of coverage". It is more specific than
the booklet. You may find an exclusion there. I am waiting to see mine,
because the booklet shows nothing.
— Janelle H.
February 19, 2001
I dont know that much about insurance coverage, and if your state of
residence plays a role, but I had United Healthcare PPO and it was totally
covered for lap. Email me directly if you need any additional information.
— Anna B.
April 8, 2001
I had UH of Louisiana and was denied in Jan 01. First they lost my paper
work. It took 2 months to for a reply! They stated "not a covered
procedure". Since I have changed ins. carriers.
— Pam B.
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