Question:
Did anyone have trouble getting approved by United Health Care (HMO)?
— Becky M. (posted on July 7, 2002)
July 7, 2002
It all depends on your policy. If it is a covered benefit, they have no
problem with approving you. But if it is not a covered benefit. There is
no way that they will.
— RebeccaP
July 7, 2002
I don't know which policy you have with United but I also have United and
it only took them exactly one week to approve me for my surgery. Matter
fact I was very impressed with them - after the approval one of their
representatives called me and discussed the surgery (pros and cons) with
me. I found that to be extremely nice.
— Can9603
July 7, 2002
I also have UHC HMO and I posted on this site to see what type experiances
others with the same policy had which really only gave me false hopes as
the same exact plan can differ from one company to the next. You can save
yourself a lot of time by calling the number on your card, but ask for
someone in "care coordination" not customer service.. all they
will do is tell you if there is or is not an exclusion, (then probobly give
you their personal opinion about this surgery) they have no power to do
anything.. IF you have an exclusion you are probobly done for! 2 types of
exclusions...one is thru UHC, the other is in the contract thru your
employer (this is the case with me) It took me over a week to get to the
bottom of exactly WHO had the exclusion. My suggestion is...read your
certificate of coverage. Then call UHC..then call your human resource
department and talk with your benefit's coordinator... Find out where the
exclusion is coming from! I live in Ga and we have "special
legislation" (HA!) that "suggests" insurance companies pay
for obesity treatment but they still don't have to. I submitted a letter
with copies of 3 senate bills to my HR. They have the POWER to remove the
exclusion. I am still waiting to hear. IF they choose to remove the
exclusion it will be next year.. Hopefully you will have better luck than
I am. Some employers will actually remove the exclusion when they are
educated on this surgery. Another thing I have learned is apparantly the
HMO is a cheaper policy, therefore doesn't offer as much coverage as the
PPO... UHC PPO's generally do not have an exclusion! After this I should
qualify to work for an insurance company or maybe the insurance
commishioner! (Who I by the way I sent a letter to, in addition to a
letter to the senator for my district, no response from either..) Anyway,
go ahead and call, save yourself the wondering and worry so you can move on
to your next plan of action if they say NO! Good luck! Pam
— Pam B.
July 8, 2002
Hi there. I know that United has a million different plans. See if there
is a website you can visit. I have United Health care PPO and my surgery
was approved with one PHONE CALL. Every plan is different, but my
experience was great! Hanng in there.
— Annie E.
July 8, 2002
Hi Becky, Like most of the answers to your question state, UHC has about a
million different policies. At the company I work for, UHC did not even
provide benefits booklets. Then when I called them in February (I talked
to someone in customer service and someone in care coordination), they told
me I was 100% covered if I met medical criteria. I do. Well, to make a
long story short, when the surgeon's office sent in for preauthorization, I
was denied based on a contract exclusion with my employer. I called the
benefits coordinator at corporate, and was told there is no exclusion on my
policy. She also sent this to me in writing in the form of an e-mail. The
benefits coordinator AND the insurance contact at my surgeon's office had
to specifically request that NO EXCLUSIONS be posted and comitted to the
notes field in my policy coverage at UHC. Still, it took three weeks,
numerous phone calls and e-mails, and a final phone call of nearly 1 and
1/2 hours to get them to give a preauth number.
Don't give up. That is what they are trying to get you to do... By the
way I have UHC Select EPO.
— CatLover1964
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