Question:
Approval with United Heath Care??

I just called UHC to get status of my pre-cert for WLS. The rep checked and said that my pre-cert was now in the final stages and with a director. She said that I should know something next week. Does this mean that the UHC nurse gave the thumbs up?? Or does it mean that I might get a denial??    — S A. (posted on May 16, 2003)

May 16, 2003
WHEN A PROCEDURE IS A HIGH COST ITEM OR PROCEDURES THAT BORDER ON BEING COSMETIC/INVESTIGATIONAL THEY REQUIRE WHAT IS CALLED PRE DETERMINATION. THE MEDICAL DIRECTOR WILL REVIEW YOUR CASE AND ALL CLINICALS ATTACHED TO IT AND WILL DETERMINE IF YOUR REQUEST IS MEDICALLY NECESSARY. i DO NOT WORK FOR UNITED HEALTHCARE BUT I AM A PRE CERT NURSE AT AN INSURANCE COMPANY BY TRADE AND THIS IS WHAT I DO EVERY DAY. YOUR REQUEST COULD GO EITHER WAY APPROVED OR DENIED. I REALLY WISH YOU THE BEST IN THIS GOOD LUCK
   — Tanya J.

May 16, 2003
I did work for UHC as a medical review nurse. It means that your chart is on the desk of the medical reviewer and in the process of being reviewed for medical necessity. You're still waiting to hear the outcome at this point. Best of luck to you!
   — ZZ S.