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JillinWarren
on 12/1/10 12:11 am - Warren, NJ
on 12/1/10 12:11 am - Warren, NJ
Topic: RE: Insurance Denied by Dr Bertha with 2 weeks to surgery date
I found another surgeon, but Dr Bertha could have made an exception for an EXISTING PATIENT and HE DID NOT. United Healthcare didn't cause me any problems personally.
This was all about the dispute between Bertha and UNC, and I was just in his "pipeline" in case it was resolved. He wasn't going to get enough MONEY for my surgery, so he dropped me despite my compliance with his instructions. His only interest in me was his fee, not patient care.
This has cost me HOURS and DAYS and money to get another surgery lined up, and isn't final yet. It will cost me THOUSANDS MORE if it is pushed into 2011.
His office did not provide my medical records to other doctors in a timely fashion, so cost me another few weeks!
BEWARE BERTHA!!!!!!!!!!!!!!!!!!!!
Jill
This was all about the dispute between Bertha and UNC, and I was just in his "pipeline" in case it was resolved. He wasn't going to get enough MONEY for my surgery, so he dropped me despite my compliance with his instructions. His only interest in me was his fee, not patient care.
This has cost me HOURS and DAYS and money to get another surgery lined up, and isn't final yet. It will cost me THOUSANDS MORE if it is pushed into 2011.
His office did not provide my medical records to other doctors in a timely fashion, so cost me another few weeks!
BEWARE BERTHA!!!!!!!!!!!!!!!!!!!!
Jill
Topic: Can't get insurance after wls?
I had lap band surgery, self-pay, a little over four years ago. I moved out of state, and need to get new insurance. We currently have BCBS of AL, and they only cover if we are in the state. We can transfer the policy to BCBS of FL, but for some reason, our premiums will jump by a third to keep basically the same policy (which, of course, excludes anything related to the lap band, since I was self-pay). We inquired about getting an entirely new policy, which would actually cost less, but they said I cannot get a new policy until I am five years out from surgery, without complications. The only "complications" I have had were port replacement for cosmetic reasons (old style port was visible and replaced with low-profile port), and gall bladder removal. I don't know if either of those will impact my ability to get insurance after my five year anniversary in Sept. '11.
Has anyone else had trouble getting health insurance after weight loss surgery? How did you handle it?
Has anyone else had trouble getting health insurance after weight loss surgery? How did you handle it?
Topic: RE: UHC (united) billing weirdness and lagging on approval...
I definately understand your frustration.
1. Since the file is with the medical director, call UHC and tell them that you would like to speak to someone in the Medical Director's office. DO NOT TAKE NO FOR AN ANSWER. (However, you may have to agree to a call back for this). Once you get to the office, explain to them that your file has been with UHC for 3.5 weeks and you would like to know when you can expect a decision. The fact that it is with a medical director is not necessarily a bad thing.
2. Pull a copy of your policy. (If you dont have one, you can get it from your employer. The law requires that you be able to obtain a copy) Does your policy limit the nutrition visits? if it doesn't specifically say anything, then APPEAL and reference your policy. Even if it does limit them, appeal but then reference the fact that the nutrition classes are their prerequestite for WLS. As for being told that "all pre-op visits would be covered", some insurance plans does not consider nutrition plans to be a pre-op visit since you are usually not meeting with a physician or a PA. (Yes this is stupid)
3. APPEAL the radiology tests. Most companies do require their appeals in writing. In this appeal, cite your policy. It will strengthen your case.
4. My psych eval took 4 weeks to pay. As long as your are sure that it was billed, you need to wait to see if they pay. While you are waiting, look at your policy and see if there is an exclusion for mental health. If their isn't, you have an appeal if they do deny.
I know that having to appeal is a hassle and they do tend to take about 30 days. However, it is much better than having to come out of pocket for costs that should be paid. I hope it all resolves quickly and that you have your approval.
GOOD LUCK!!!
1. Since the file is with the medical director, call UHC and tell them that you would like to speak to someone in the Medical Director's office. DO NOT TAKE NO FOR AN ANSWER. (However, you may have to agree to a call back for this). Once you get to the office, explain to them that your file has been with UHC for 3.5 weeks and you would like to know when you can expect a decision. The fact that it is with a medical director is not necessarily a bad thing.
2. Pull a copy of your policy. (If you dont have one, you can get it from your employer. The law requires that you be able to obtain a copy) Does your policy limit the nutrition visits? if it doesn't specifically say anything, then APPEAL and reference your policy. Even if it does limit them, appeal but then reference the fact that the nutrition classes are their prerequestite for WLS. As for being told that "all pre-op visits would be covered", some insurance plans does not consider nutrition plans to be a pre-op visit since you are usually not meeting with a physician or a PA. (Yes this is stupid)
3. APPEAL the radiology tests. Most companies do require their appeals in writing. In this appeal, cite your policy. It will strengthen your case.
4. My psych eval took 4 weeks to pay. As long as your are sure that it was billed, you need to wait to see if they pay. While you are waiting, look at your policy and see if there is an exclusion for mental health. If their isn't, you have an appeal if they do deny.
I know that having to appeal is a hassle and they do tend to take about 30 days. However, it is much better than having to come out of pocket for costs that should be paid. I hope it all resolves quickly and that you have your approval.
GOOD LUCK!!!
Top is my progress, Bottom is to Surgeon's Goal
Topic: RE: UHC (united) billing weirdness and lagging on approval...
I have UHC EPO (no deductible and my plan is supposed to cover everything the PPO does as long as i'm in-network, with a copay of $10 per visit for most everything)... I spent a few hours playing phone tag today and was told:
1) my surgery is still pending decision. the medical director has it (not sure if that's normal?). my surgeons office as of this morning said they hadn't heard anything back. this submission was after the first one was closed and had to be re-opened because the UHC adjuster was being super impatient about getting the paperwork completed within 24 hours.. (my surgeons office was missing one year of weights and UHC wouldnt wait an extra day to get it faxed over)
2) although they insisted i do 6 nutrition visits and in the course of the same conversation said all pre-op visits would be covered under my plan, they are now deciding to only pay for 2 of them and now say my plan only covers 3 nutrition visits per lifetime per diagnosis... and they counted my intro bariatric class as another visit. WTF.
3) the two main radiology tests they denied (for no noted reason) - upper GI and chest xray - they told me should be covered and the doctors are in-network YET they still wouldn't fix it for me on the phone. they said they'll put it "under review" and i should know IF they fix it in 10 biz days.... double-WTF.
4) the psych eval (done a month ago, still no reimbursement) i have to deal with another UHC phone bank to make sure they cover, since i was explicitly told before making the appt by a UHC rep that it would indeed be covered.
big hassle. all of that, plus just the last few months of copays for visits, tests and such = $1500. that doesn't count the meds UHC won't cover (heavy duty iron and vit D) and prior months of copays re: surgery. i'm not made of money and my plan is supposed to cover most costs, so this is super annoying. i hope it all gets resolved soon.
1) my surgery is still pending decision. the medical director has it (not sure if that's normal?). my surgeons office as of this morning said they hadn't heard anything back. this submission was after the first one was closed and had to be re-opened because the UHC adjuster was being super impatient about getting the paperwork completed within 24 hours.. (my surgeons office was missing one year of weights and UHC wouldnt wait an extra day to get it faxed over)
2) although they insisted i do 6 nutrition visits and in the course of the same conversation said all pre-op visits would be covered under my plan, they are now deciding to only pay for 2 of them and now say my plan only covers 3 nutrition visits per lifetime per diagnosis... and they counted my intro bariatric class as another visit. WTF.
3) the two main radiology tests they denied (for no noted reason) - upper GI and chest xray - they told me should be covered and the doctors are in-network YET they still wouldn't fix it for me on the phone. they said they'll put it "under review" and i should know IF they fix it in 10 biz days.... double-WTF.
4) the psych eval (done a month ago, still no reimbursement) i have to deal with another UHC phone bank to make sure they cover, since i was explicitly told before making the appt by a UHC rep that it would indeed be covered.
big hassle. all of that, plus just the last few months of copays for visits, tests and such = $1500. that doesn't count the meds UHC won't cover (heavy duty iron and vit D) and prior months of copays re: surgery. i'm not made of money and my plan is supposed to cover most costs, so this is super annoying. i hope it all gets resolved soon.
Topic: RE: UHC (united) billing weirdness and lagging on approval...
Without knowing the specifics of your plan it is hard to figure out what is going on. Do you have a deductible that needs to be met? what is your cost-share? UHC usually processes my claims within 48 hours. I would suggest looking at your EOBs (Explanation of Benefits), you can access them online, and see where the amount you owe is coming from. There is also the possibility that the insurance company wasn't billed correctly. Then take a look at your coverage, if you disagree with the way they have applied any of the billing/payments, then appeal. I know I have a deductible of $1250 so I was responsible for some of my pre-op testing.
As for your approval, call UHC. 3.5 weeks is a long time for them. Its possible that something is missing and they have contacted your surgeon (either via phone or in writing). However, you will not know unless you call them and ask.
As for your approval, call UHC. 3.5 weeks is a long time for them. Its possible that something is missing and they have contacted your surgeon (either via phone or in writing). However, you will not know unless you call them and ask.
Top is my progress, Bottom is to Surgeon's Goal
Topic: My Empoyer's Plan vs my stoma
My employer's healthcare plan specifically states one bariatric procedure per lifetime. However, my surgeon has stated that I require a Band Over Bypass to correct a dilated stoma (staples came out of place ).... The insurance rules this BOB a second bariatric procedure not a correction to the RNY....
Has anyone had any experience appealing for an exception/waiver to the Empoyer's Plan???
Has anyone had any experience appealing for an exception/waiver to the Empoyer's Plan???
Topic: UHC (united) billing weirdness and lagging on approval...
I don't know if this is happening to anyone else with United Healthcare but they're really ticking me off lately. The insurance coordinator at my surgeons office told me their rep said all the pre-op tests were covered under my plan.... yet I got a bill for about $1200 of tests they completely did not cover... WTF. And my paperwork was all submitted about 3.5 weeks ago and still no response. I've seen some people on the boards talk about UHC having a quick response and being easy to work with, so this is a bit frustrating.
Is anyone else having similar issues with UHC lately?
Is anyone else having similar issues with UHC lately?
Topic: RE: United Heath Care
I have United Healthcare and VSG was an option for me. However, whether or not your brother's plan will cover it is dependent upon his employer. His best bet it to call them and see if his employer has purchased the "Bariatric Resource Service" through UHC. If so, he will be assigned a case manager that will walk him through the entire process including fast tracking the approval once all the paperwork is in.
Good luck!!
Good luck!!
Top is my progress, Bottom is to Surgeon's Goal
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