Question:
Has anyone been denied by United Healthcare?

my doctor orig. filed with CIGNA HMO in June and they denied because they needed more info, then July 1st our insurance co was switched so my doc refiled with United Healthcare and they denied because it is not a covered procedure, even if medically necessary.    — Rhonda S. (posted on July 14, 2000)


July 14, 2000
I was approve by UnitedHealthCare and my surgery is schudale for July 26, 2000, however I had another doctor check into it and they told him it wasnt covered....and I know of another lady with our insurance has already had the surgery and they paid for it.....if you go to your PCP first then have them refer you it gets approve alot easier let them get the referral approve first ........
   — patrioticwife

July 14, 2000
I have United Health Care of NC. This week after waiting over 4 weeks and many phone calls to them they now tell me that my request was sent back to the customer service area due to the exclusion clause. They said this was not a denial because they did not even consider it. I was told I have the right to appeal but it is not a covered benefit. There are many out there that have UNC but it depends on the type of plan you have. I do plan to appeal.
   — Glenda E.

July 14, 2000
I have United Healthcare Choice HMO in Maryland, and although my experience has been very limited so far, I must admit it's been somewhat discouraging. Depending on who you speak with at customer service, you are told everything from UHC not covering the surgery no matter what the circumstance to them covering it, but only under the most severe. I've made it a point to call them at least four times to see if the answer is the same. I've realized that although it can be a covered procedure under the right circumstances, you pratically have to "pry" the info from them to get a truthful answer. Be persistent, ask tons of questions, and hang in there!
   — Kimberly D.

July 15, 2000
I have united health care select hmo and had the surgery in april 12, 2000. It might depend on option your employer said they would pay for. Most everyone on this sight that had united health care has been approved from what i read.
   — Sharon T.

July 15, 2000
I have United HealthCare POS and had the WLS done on March 22, 2000. My surgeon submitted the request and was approved within about 2 weeks. Don't give up!
   — Jonna B.

July 29, 2000
my doctor's office said taht they sent my clinicals to uhc on 6-9-00. after a month and ahalf of waiting i started to call them almost everyday to see if they had it yet. finnaly i was able to tt tanya a customer advocate with uhc. she gave me a fax # that my doc could fax the clinicals to.i thought that everything would be great from there but then toe paperwork was sent to the wrong office. well as of yesterday i tt linda a nurse who is reviewing my case for approval, and she has everything nad said she will call my doc as soon a a decision was made. i don't blame the insurance company for the hold up. i just wish that everyone could be on the same page. the people i've tt at united health have been extreamly friendly nad courtous.
   — shannon P.

July 29, 2000
I have UnitedHealthcare POS and had surgery May 1. I was approved in 2 days. Do you have an exclusion in the policy? If so, talk to your HR department. UHC puts into the policy whatever your employer wants them to cover. Good luck!
   — Maxine E.

August 12, 2000
Approval depends entirely on whether your specific policy has a written exclusion. Mine does. In two appeals, the committee has basically agreed that my doctor makes a good case for the medical necessity, but that it cannot be covered because it is a specific exclusion. I am looking at whether to take it up with my employer or look at legal action or what, as I have absolutely no resources (like home equity) to pay for it myself without insurance help.
   — Mary Ann M.

February 19, 2001
I am in your situation right now. They approve open but not lap, which Dr. Alverdy refuses to do (in my case). I have sent studies dating back from 1993, the doctor has written letters, they will not budge. I filed a complaint with the Department of Insurance and wrote letters to my congressman. Getting government officials involved will carry more weight (as the Dept of Ins advised). UHC has asked for an extension until 2-22-01. My advise is to use more than your insurance booklet. Have your company send you the "certificate of coverage". It is more specific than the booklet. You may find an exclusion there. I am waiting to see mine, because the booklet shows nothing.
   — Janelle H.

February 19, 2001
I dont know that much about insurance coverage, and if your state of residence plays a role, but I had United Healthcare PPO and it was totally covered for lap. Email me directly if you need any additional information.
   — Anna B.

April 8, 2001
I had UH of Louisiana and was denied in Jan 01. First they lost my paper work. It took 2 months to for a reply! They stated "not a covered procedure". Since I have changed ins. carriers.
   — Pam B.




Click Here to Return
×