Additional Questions about UHC

grammi · 03-23-2005, 02:21 PM

AS I told you all several days ago I have been approved by UHC. However, the letter stated I was approved but the approval did not guarantee payment...what the hay! I am trying to to get hold of someone that may answer....if anyone received the same letter from UHC will you let me know how the ayment went etc. We are covered under the railroad's contract and currently only pay $15 per visit, emergency and hospital included. Also, my doctor has not contacted me and if I have all of these tests to get set up. He is Dr. Jessie Lopez in Overland Park, Kansas so if anyone has any info on him I would appreciate that also.

Thanks all for listening to me babble.

New Hope · 03-23-2005, 02:25 PM

Your best bet will be to contact your Benefits Coordinator for the specifics.

daisydoodle · 03-23-2005, 02:28 PM

I thought I replied to this already...but it's not showing up! Anyhoo...I'm pretty sure we have the same coverage with UHC. My husband also works for the railroad. I received the same letter that you did and my surgery was paid for in full. Just make sure you use and in-network facility and that your anestesiologist is also in-network.
Good Luck to you!

gunn4ya · 03-23-2005, 02:32 PM

I got the same letter for UHC but i called them and yes everything will be covered as long as it's in network.

hrv · 03-23-2005, 03:34 PM

Mine was the same and my surgery is also paid for. Congratulations!!!

grammi · 03-23-2005, 03:54 PM

You guys are great...thanks. I FINALLY got through to a Benefits Coordinator and they told me the same thing. I was panicking a little. Now if I can get my doc to get on the ball. I know patients is a virtue!

porclndoll · 03-23-2005, 06:00 PM

basically that letter is sent because they did a predetermination on one procedure...if something happens along the way and they did a diffrent procedure than the one that was autherized, then the payment wouldn't be allowed. however, in the case of emergencies thats a diffrent story...........but if you had the lap band autherized and then desided on the morning of the surgery to do the gastric bypass, payment would be withheld. i hope this clears that up a little more for ya.....i worked at empire for a while and got this same call a hundred times......

**Alexandra** · 03-23-2005, 06:01 PM

Just FYI, approval letters never guarantee payment. Payment decisions are always made only AFTER the claim comes in. There are still all sorts of technical reasons why a claim might be denied even with an approval in place. The carrier has to cover its butt by letting you know you still have to comply with x,y,z provisions of the contract and claim process before they will make a payment decision.

But it's standard language and nothing to worry about. You're good to go!! :D