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2nd appeal denied by UHC

AnonymousUserAAnonymousUser Posts: 49,622
edited 06/11/2012 - 7:27 AM in Back Surgery and Neck Surgery
Hi everyone,
I received bad news today. I was denied by united heathcare for the 2nd time for ADR surgery. my surgeon and me have done everything right to get an appeal processed in favor, but UHC insists that it is an unproven service. Anyone out there have any advice or suggestions. I really don't want to have a fusion.

thanks everyone

gary
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Comments

  • I'm sorry to hear that Gary, they just want to take the cheapest way out without regard for the best interest of a patient. They are probably pushing your doctor to do a fusion instead. What type of problem are you having?
  • I have been denied for fusion 2 times before I got it. I had to go to the state level for a appeal and then they send The CEO had a different manager look at it. The manager called me on Friday and said she would look at my file over the weekend. She did and called me Monday and apologized to me saying I should have not had to go through all of it. She approved it in network, since it was out of network and said that it would be expedited. SO, go to state level. Have your Dr write a letter on your behalf, (Mine wrote a 6 page) and after they send it to reviewer, send eveything you have as far as tests, PT, and Drs notes along with a letter explaining your problems to the independant reviewer. Do not send this to state. Send it to reviewer after you find out who it is. And see how that goes. It is your best shot at getting something done. Also, if your company says it is experiemental, have Dr send letter explaining why it is not, like studies and statisitics. Good Luck my friend. It worked for me. After Lots of aggrevation. Just go to state and start your appeal at division of insurance and file appeal there. And you are on your way. Hope this helps and PM me f you want any more info.
  • I am going through the same thing! Mine is not for an ADR but insurance is refusing to pay. I am also in appeals right now. Very frustrating. I think that the insurance companies are tightening their belts like everyone else. People who have had the fusion done and are feeling better are lucky, they may not have gotten it approved now.
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