2 Denials, 3 Appeals, 1 APPROVAL!!! Date set!!!

LynneB · 02-22-2008, 07:25 PM

I got my approval today from UHC!!!!!!!! I faxed my Cap One financing contract in yesterday to my Dr & they were faxing it in today but decided to call UHC for one final check on my 3rd appeal & they overturned my denial!! I was so happy I was in tears w/ the billing girl from my Dr's office. 3 months of fighting paid off. My surgery is set for April 11th. No turning back now! I could have set the date sooner but I just paid $2,000 for a 3 night trip to Disney World for spring break & I dont want to be 3 weeks out from surgery & trying to walk around amusement parks for 3 days. I am still in shock! My Dr made UHC fax over the approval in writing since they gave verbal approval a month ago & then rescinded it the day before surgery so it is official! I am gonna be a bandster, finally!! I dont think I have felt this happy in years!!

bsmith56 · 02-22-2008, 07:48 PM

Congrats. Have fun at DW.

sahmof3 · 02-22-2008, 07:57 PM

Congrats! I have UHC and was approved in 4 days. Why did you have such a hard time? I see that most people get approve pretty quick, but there are a few that things just done go as smooth. My best friend was one. It took her two months and her BMI is higher then mine and she has co-morbidities where I don't. My BMI is over 40.

Oh, I will be in DW in May. This must be the year. Everyone I talk to is going.

LynneB · 02-22-2008, 08:03 PM

They claim it was denied based on it being an exclusion. Apparently the morons couldnt read my contract where it said "exception" to the exclusion was if it was medically necessary and auth by a physician. It took me threatening them with an atty on my 3rd appeal to get them to stop giving me such a hard time.

Chris61 · 03-04-2008, 01:12 PM

Thats great to here that you were approved. Amazing how people have a hard time reading and understanding things. I think that is what is the biggest problem with insurance and getting approved.

Chris

Angie4b1g · 03-04-2008, 01:24 PM

AWESOME news!

AmandaJene · 03-06-2008, 09:42 PM

Hi, I have UHC also and I got a denial saying that WLS is an exclusion on my policy. I was wondering if you could give me any tips on what to do about an appeal. My surgeon's office doesn't seem to be really convinced that an appeal will work. What the heck, you'd think that insurance companies would see how much cheaper it would be to approve the surgery for those that need it and not just want it. Any advice would be helpful!

Little Debbie · 03-06-2008, 09:53 PM

I was wondering if anyone has Health Net HMO AND a Sutter Gould PCP? I had to get approval from a review board just to get a referral to the Lap Band Doctor, and that was after my PCP approved it. I am hoping that that means I am a shoe in for getting the surgery approved. Anyone know anything about that?
Thanks

jbflorida · 03-06-2008, 10:22 PM

Counting the days--congrats! I have an exclusion. How can I find out what I am really entitled to? How do you do an appeal? Please share the steps you took. I would be sooo grateful.

And tell me about the doc in Bradenton....(I am about 30 minutes north....)

MacMadame · 03-06-2008, 10:59 PM

Quote:

Originally Posted by jbflorida

How can I find out what I am really entitled to?

Ask for a copy of your plan. Not the plan summary but the full plan with all the details and the exact language.

sahmof3 · 03-07-2008, 12:32 PM

Quote:

Originally Posted by AmandaJene

Hi, I have UHC also and I got a denial saying that WLS is an exclusion on my policy. I was wondering if you could give me any tips on what to do about an appeal. My surgeon's office doesn't seem to be really convinced that an appeal will work. What the heck, you'd think that insurance companies would see how much cheaper it would be to approve the surgery for those that need it and not just want it. Any advice would be helpful!

From what I understand, if the company you work for as it as an exclusion there is no turning it over. I don't think an appeal will work. You can try going to your HR dept and see if they can do something.

Maybe someone else will have something different to say.

Good luck!

LynneB · 03-07-2008, 02:42 PM

In my case my contract stated it was an exclusion unless authorized by a physician for medical reasons. If your contract does not have that exception then there is no overturning the decision. To do an appeal you simply get together any other supporting medical records that you didnt originally send in and type up a personal appeal letter to go with the records.