Question:
MVP or United Healthcare Ins. in N.Y.S.

Does anyone have any pro/con info on either Ins.? I am in Syracuse I was denied WLS by BC/BS Onpoint 1 yr. ago due to exclusion, I changed to HealthNow during open enrollment 1/04 and just received a letter from my employer there is unresolved contract issues between employer & HealthNow, so now I must change to MVP or UHC any suggestions?    — Tom C. (posted on January 27, 2004)

January 26, 2004
My advice to you is to get the customer service number of both and call them. You did not say whether you still work for the same place (i.e. if the BCBS was thru the same employer). Exclusions are mostly something the purchaser (your employee) places in their contract to reduce cost to them. I don't want to sound discouraging but I would think if they put an exclusion on one option, they'd do it for another. I do have positive info as well. My employer offers 6 insurance options through 4 different companies and everyone around here shares info. We do NOT have an exclusion in our policies and so far the best option was United Health Care (either the PPO or the EPO). Everyone who has the other companies (Cigna, Mayo, Aetna) has to jump through all sorts of hoops before they get approved. UHC approves like lightning if you meet the requirements and their requirements are basic. THEY called ME to tell me I was approved before I even knew the Dr. had submitted. They even said sweet things about how I'd be feeling better very soon, etc. I have nothing but GLOWING remarks on UHC. :)
   — Donya P.

January 27, 2004
Tom, you should know that exclusions are not valid in NYS. New York State law requires that if your doctor says its medically necessary the insurance company MUST cover the surgery. What you would do is appeal the first decision if it's a denial and if they deny it again they MUST tell you how to appeal to the State for an external review. As long as the plan isnt self insured or written in another state new york will require them to cover it. Any questions email me. UHC is just as bad as cigna. But like I said the state will help you. I havent lost one appeal yet in New York. Actually not one in the US yet. BUt New York as far as appeals goes is very good. I was lucky, my surgery was covered first try. Good luck. Gary Viscio, Esq.
   — gary viscio

January 27, 2004
I have MVP and was approved within a week back in June of last year. No problems at all. Good luck.
   — Krista S

January 27, 2004
Hey Tom. I have MVP and I was approved within 4 weeks for my gastric bypass, and I also had reconstructive surgery as well this past fall and was approved for that within a week. I know a few other people who also had MVP and had no problems.
   — Shavonne P.

January 28, 2004
I have United Health Care(Premium Plan) and live on Long Island. I had open RNY Dec 3 03 and have just gotten all the bills in. I am happy to say they covered all the bills from the surgery except, of course, for my $20 co-pay. I have been very pleased with this company. I don't know if the coverage is so good because we have the top plan or not. Hope this helps a little. Good Luck
   — Judith W.