Re: - Insurance advice needed - United Healthcare

[Guest guest]

,

I am so frustrated with this insurance company right now - after

being given the run around and different answers on what I could do

to appeal and try to get this covered - I finally went to someone

high up in my company who made a phone call to them (I didn't want

to bother them with this, but was told that I may need to get them

involved). She is the one that writes the huge check to the

insurance company every month for the employees (our company pays

the monthly insurance bills for us as one of our benefits) - and she

got the same run around and the same kind of answers as I did -

nothing was consistent. She finally said " I am not getting off this

phone until I can speak to the highest person who is working in that

office today and get an answer on what needs to be done to get this

covered - if it is something that we need to do as a company we need

to know and we will do it - I write a check for $xx amount of

dollars every month and.... " She actually got somewhere - not only

did we get a supervisor on the phone, but I think the poor woman is

scared - she called me 3 times yesterday with an update everytime

she did something new regarding my case. She personally is tracking

all the stuff my surgeon sent, made phone calls to his office, sent

my appeal letter to the proper person, etc. She is aware of the

situation that I am in (surgery is scheduled this month) and is

doing everything to help me. My company has said that they will do

anything they can to help me get this covered if United Healthcare

can't make an exception to my case - they said that they will try to

have it written into their contract (one time exception) for me if

need be. She said that if United Healthcare won't make the

exception that she will contact my superior and have a meeting to

figure out how this can be written into the contract.

United Healthcare said that it takes about 5-7 days to have

everything filmed in their computer, but they can read the notes

that others have inputted. As someone else suggested here, to get

anywhere with this company you should try to talk to a supervisor -

the reps. are not consistent with their answers from what I have

experienced (I called like 5 times the same day to try to get the

answer on what I needed to do and the next step I need to take - I

finally went to our Chief Financial Officer because each time I was

told what to do next differently - I could appeal - I couldn't

appeal because they will never make an exception since my company

didn't pick up the option - that my company needs to make an

exception to get this covered - that my company couldn't make an

exception, etc. - what the...?) and plus I think that they just try

to give you any answer to get you off the phone. Keep calling and

try to get that supervisor on the phone if you can.

Persistance yes - patience no way (lol)- over that!

Keep me posted!

[Guest guest]

,

I am so frustrated with this insurance company right now - after

being given the run around and different answers on what I could do

to appeal and try to get this covered - I finally went to someone

high up in my company who made a phone call to them (I didn't want

to bother them with this, but was told that I may need to get them

involved). She is the one that writes the huge check to the

insurance company every month for the employees (our company pays

the monthly insurance bills for us as one of our benefits) - and she

got the same run around and the same kind of answers as I did -

nothing was consistent. She finally said " I am not getting off this

phone until I can speak to the highest person who is working in that

office today and get an answer on what needs to be done to get this

covered - if it is something that we need to do as a company we need

to know and we will do it - I write a check for $xx amount of

dollars every month and.... " She actually got somewhere - not only

did we get a supervisor on the phone, but I think the poor woman is

scared - she called me 3 times yesterday with an update everytime

she did something new regarding my case. She personally is tracking

all the stuff my surgeon sent, made phone calls to his office, sent

my appeal letter to the proper person, etc. She is aware of the

situation that I am in (surgery is scheduled this month) and is

doing everything to help me. My company has said that they will do

anything they can to help me get this covered if United Healthcare

can't make an exception to my case - they said that they will try to

have it written into their contract (one time exception) for me if

need be. She said that if United Healthcare won't make the

exception that she will contact my superior and have a meeting to

figure out how this can be written into the contract.

United Healthcare said that it takes about 5-7 days to have

everything filmed in their computer, but they can read the notes

that others have inputted. As someone else suggested here, to get

anywhere with this company you should try to talk to a supervisor -

the reps. are not consistent with their answers from what I have

experienced (I called like 5 times the same day to try to get the

answer on what I needed to do and the next step I need to take - I

finally went to our Chief Financial Officer because each time I was

told what to do next differently - I could appeal - I couldn't

appeal because they will never make an exception since my company

didn't pick up the option - that my company needs to make an

exception to get this covered - that my company couldn't make an

exception, etc. - what the...?) and plus I think that they just try

to give you any answer to get you off the phone. Keep calling and

try to get that supervisor on the phone if you can.

Persistance yes - patience no way (lol)- over that!

Keep me posted!

[Guest guest]

Hi again . I understand your frustration (especially with your

surgery so soon). It's at least good that your company is on your

side. I'm glad you were able to get to a UHC person that can tell

you what's going on. The HR or Benefits area of your company should

be able to tell you more about the next level of appeals (if there

is one). My husband's company (IBM) had some information on the 2nd

level of appeal on the IBM intranet site for employees. I also

confirmed with IBM's Benefits dept. that there is a 2nd level of

appeal, which is through IBM, not UHC.

I just received a letter in today's mail (Saturday) stating that my

case is in appeals. I'm not sure how a case goes to appeals when

neither or nor my doctor never received written notice of denial,

but now I have another name & phone number to call. What part of

the country did your appeals go to? Mine went to San , TX &

the letter is from Pitzer, Appeals Coordinator. They stated

they will notify me in writing within 15 days of their decision.

Guess I better start planning my phone calls to them for Monday

morning! Good luck to you too.

P.S. There is an ERISA internet site too if you haven't already

seen it. (just search " ERISA " on google or yahoo). It may not help

much, but just wanted you to know it's there.

> ,

> I am so frustrated with this insurance company right now - after

> being given the run around and different answers on what I could

do

> to appeal and try to get this covered - I finally went to someone

> high up in my company who made a phone call to them (I didn't want

> to bother them with this, but was told that I may need to get them

> involved). She is the one that writes the huge check to the

> insurance company every month for the employees (our company pays

> the monthly insurance bills for us as one of our benefits) - and

she

> got the same run around and the same kind of answers as I did -

> nothing was consistent. She finally said " I am not getting off

this

> phone until I can speak to the highest person who is working in

that

> office today and get an answer on what needs to be done to get

this

> covered - if it is something that we need to do as a company we

need

> to know and we will do it - I write a check for $xx amount of

> dollars every month and.... " She actually got somewhere - not

only

> did we get a supervisor on the phone, but I think the poor woman

is

> scared - she called me 3 times yesterday with an update everytime

> she did something new regarding my case. She personally is

tracking

> all the stuff my surgeon sent, made phone calls to his office,

sent

> my appeal letter to the proper person, etc. She is aware of the

> situation that I am in (surgery is scheduled this month) and is

> doing everything to help me. My company has said that they will

do

> anything they can to help me get this covered if United Healthcare

> can't make an exception to my case - they said that they will try

to

> have it written into their contract (one time exception) for me if

> need be. She said that if United Healthcare won't make the

> exception that she will contact my superior and have a meeting to

> figure out how this can be written into the contract.

> United Healthcare said that it takes about 5-7 days to have

> everything filmed in their computer, but they can read the notes

> that others have inputted. As someone else suggested here, to get

> anywhere with this company you should try to talk to a supervisor -

> the reps. are not consistent with their answers from what I have

> experienced (I called like 5 times the same day to try to get the

> answer on what I needed to do and the next step I need to take - I

> finally went to our Chief Financial Officer because each time I

was

> told what to do next differently - I could appeal - I couldn't

> appeal because they will never make an exception since my company

> didn't pick up the option - that my company needs to make an

> exception to get this covered - that my company couldn't make an

> exception, etc. - what the...?) and plus I think that they just

try

> to give you any answer to get you off the phone. Keep calling and

> try to get that supervisor on the phone if you can.

> Persistance yes - patience no way (lol)- over that!

> Keep me posted!

>

[Guest guest]

Hi again . I understand your frustration (especially with your

surgery so soon). It's at least good that your company is on your

side. I'm glad you were able to get to a UHC person that can tell

you what's going on. The HR or Benefits area of your company should

be able to tell you more about the next level of appeals (if there

is one). My husband's company (IBM) had some information on the 2nd

level of appeal on the IBM intranet site for employees. I also

confirmed with IBM's Benefits dept. that there is a 2nd level of

appeal, which is through IBM, not UHC.

I just received a letter in today's mail (Saturday) stating that my

case is in appeals. I'm not sure how a case goes to appeals when

neither or nor my doctor never received written notice of denial,

but now I have another name & phone number to call. What part of

the country did your appeals go to? Mine went to San , TX &

the letter is from Pitzer, Appeals Coordinator. They stated

they will notify me in writing within 15 days of their decision.

Guess I better start planning my phone calls to them for Monday

morning! Good luck to you too.

P.S. There is an ERISA internet site too if you haven't already

seen it. (just search " ERISA " on google or yahoo). It may not help

much, but just wanted you to know it's there.

> ,

> I am so frustrated with this insurance company right now - after

> being given the run around and different answers on what I could

do

> to appeal and try to get this covered - I finally went to someone

> high up in my company who made a phone call to them (I didn't want

> to bother them with this, but was told that I may need to get them

> involved). She is the one that writes the huge check to the

> insurance company every month for the employees (our company pays

> the monthly insurance bills for us as one of our benefits) - and

she

> got the same run around and the same kind of answers as I did -

> nothing was consistent. She finally said " I am not getting off

this

> phone until I can speak to the highest person who is working in

that

> office today and get an answer on what needs to be done to get

this

> covered - if it is something that we need to do as a company we

need

> to know and we will do it - I write a check for $xx amount of

> dollars every month and.... " She actually got somewhere - not

only

> did we get a supervisor on the phone, but I think the poor woman

is

> scared - she called me 3 times yesterday with an update everytime

> she did something new regarding my case. She personally is

tracking

> all the stuff my surgeon sent, made phone calls to his office,

sent

> my appeal letter to the proper person, etc. She is aware of the

> situation that I am in (surgery is scheduled this month) and is

> doing everything to help me. My company has said that they will

do

> anything they can to help me get this covered if United Healthcare

> can't make an exception to my case - they said that they will try

to

> have it written into their contract (one time exception) for me if

> need be. She said that if United Healthcare won't make the

> exception that she will contact my superior and have a meeting to

> figure out how this can be written into the contract.

> United Healthcare said that it takes about 5-7 days to have

> everything filmed in their computer, but they can read the notes

> that others have inputted. As someone else suggested here, to get

> anywhere with this company you should try to talk to a supervisor -

> the reps. are not consistent with their answers from what I have

> experienced (I called like 5 times the same day to try to get the

> answer on what I needed to do and the next step I need to take - I

> finally went to our Chief Financial Officer because each time I

was

> told what to do next differently - I could appeal - I couldn't

> appeal because they will never make an exception since my company

> didn't pick up the option - that my company needs to make an

> exception to get this covered - that my company couldn't make an

> exception, etc. - what the...?) and plus I think that they just

try

> to give you any answer to get you off the phone. Keep calling and

> try to get that supervisor on the phone if you can.

> Persistance yes - patience no way (lol)- over that!

> Keep me posted!

>

[Guest guest]

Hi again . I understand your frustration (especially with your

surgery so soon). It's at least good that your company is on your

side. I'm glad you were able to get to a UHC person that can tell

you what's going on. The HR or Benefits area of your company should

be able to tell you more about the next level of appeals (if there

is one). My husband's company (IBM) had some information on the 2nd

level of appeal on the IBM intranet site for employees. I also

confirmed with IBM's Benefits dept. that there is a 2nd level of

appeal, which is through IBM, not UHC.

I just received a letter in today's mail (Saturday) stating that my

case is in appeals. I'm not sure how a case goes to appeals when

neither or nor my doctor never received written notice of denial,

but now I have another name & phone number to call. What part of

the country did your appeals go to? Mine went to San , TX &

the letter is from Pitzer, Appeals Coordinator. They stated

they will notify me in writing within 15 days of their decision.

Guess I better start planning my phone calls to them for Monday

morning! Good luck to you too.

P.S. There is an ERISA internet site too if you haven't already

seen it. (just search " ERISA " on google or yahoo). It may not help

much, but just wanted you to know it's there.

> ,

> I am so frustrated with this insurance company right now - after

> being given the run around and different answers on what I could

do

> to appeal and try to get this covered - I finally went to someone

> high up in my company who made a phone call to them (I didn't want

> to bother them with this, but was told that I may need to get them

> involved). She is the one that writes the huge check to the

> insurance company every month for the employees (our company pays

> the monthly insurance bills for us as one of our benefits) - and

she

> got the same run around and the same kind of answers as I did -

> nothing was consistent. She finally said " I am not getting off

this

> phone until I can speak to the highest person who is working in

that

> office today and get an answer on what needs to be done to get

this

> covered - if it is something that we need to do as a company we

need

> to know and we will do it - I write a check for $xx amount of

> dollars every month and.... " She actually got somewhere - not

only

> did we get a supervisor on the phone, but I think the poor woman

is

> scared - she called me 3 times yesterday with an update everytime

> she did something new regarding my case. She personally is

tracking

> all the stuff my surgeon sent, made phone calls to his office,

sent

> my appeal letter to the proper person, etc. She is aware of the

> situation that I am in (surgery is scheduled this month) and is

> doing everything to help me. My company has said that they will

do

> anything they can to help me get this covered if United Healthcare

> can't make an exception to my case - they said that they will try

to

> have it written into their contract (one time exception) for me if

> need be. She said that if United Healthcare won't make the

> exception that she will contact my superior and have a meeting to

> figure out how this can be written into the contract.

> United Healthcare said that it takes about 5-7 days to have

> everything filmed in their computer, but they can read the notes

> that others have inputted. As someone else suggested here, to get

> anywhere with this company you should try to talk to a supervisor -

> the reps. are not consistent with their answers from what I have

> experienced (I called like 5 times the same day to try to get the

> answer on what I needed to do and the next step I need to take - I

> finally went to our Chief Financial Officer because each time I

was

> told what to do next differently - I could appeal - I couldn't

> appeal because they will never make an exception since my company

> didn't pick up the option - that my company needs to make an

> exception to get this covered - that my company couldn't make an

> exception, etc. - what the...?) and plus I think that they just

try

> to give you any answer to get you off the phone. Keep calling and

> try to get that supervisor on the phone if you can.

> Persistance yes - patience no way (lol)- over that!

> Keep me posted!

>

[Guest guest]

,

That's great that your company is behind you just like my company has

been helping me out too in the same situation. I think I mentioned

that I have MAMSI (my husband has UHC with the same exception) and

this whole case has raised concerns of management and my coworkers

because they are now wondering what *other* unknown exceptions exist

in our policy, and how it could affect them one day. Our financial

guy also got on the phone with them to inquire and also find out if

there is something we need to do with our policy. Numerous other

phone calls were made including contacting the surgeon's office. Well

that was two weeks ago, and yesterday I received a letter in the mail

stating I have a " preliminary approval " for surgery. WOOOOO

HOOOOOOOO! It states they would not pay for orthodontic work required

to prepare for surgery, and that's just fine with me since I've

already paid for it. It also states they need additional models,

photographs, etc., when it is closer to the surgery date, but I think

that is standard. I'm hoping that this is going to work out after

all. I have a regularly scheduled ortho appt this week so I hope to

find out more, and see how long it's going to take to complete the

teeth movement that the surgeon wants to see. It may be 3-4 months

before the teeth are ready for surgery.

I think I'm going to make a copy of this letter since someone on here

posted something about a denial following an approval, and the

patient needed to prove that it had been previously approved (do I

have that right??). After reading everyone's experiences on here, I

don't think it's over til it's over, and I will keep a close watch on

the whole insurance process.

Good luck - it will work out!!

in MD

> ,

> I am so frustrated with this insurance company right now - after

> being given the run around and different answers on what I could do

> to appeal and try to get this covered - I finally went to someone

> high up in my company who made a phone call to them (I didn't want

> to bother them with this, but was told that I may need to get them

> involved). She is the one that writes the huge check to the

> insurance company every month for the employees (our company pays

> the monthly insurance bills for us as one of our benefits) - and

she

> got the same run around and the same kind of answers as I did -

> nothing was consistent. She finally said " I am not getting off

this

> phone until I can speak to the highest person who is working in

that

> office today and get an answer on what needs to be done to get this

> covered - if it is something that we need to do as a company we

need

> to know and we will do it - I write a check for $xx amount of

> dollars every month and.... " She actually got somewhere - not only

[Guest guest]

,

Hoping I hear good news this week (a letter and/or a phone call) and

not have to proceed on to the next level of appeals - hopefully we

can get an exception written in to the company's contract before I

have to resort to that.

My appeal went to the same place as yours did - San , but to

a different person - cross our fingers! We are keeping them busy

down there!

I will have to check out the ERISA website - thanks for the

additional info.

[Guest guest]

,

Hoping I hear good news this week (a letter and/or a phone call) and

not have to proceed on to the next level of appeals - hopefully we

can get an exception written in to the company's contract before I

have to resort to that.

My appeal went to the same place as yours did - San , but to

a different person - cross our fingers! We are keeping them busy

down there!

I will have to check out the ERISA website - thanks for the

additional info.

[Guest guest]

,

Hoping I hear good news this week (a letter and/or a phone call) and

not have to proceed on to the next level of appeals - hopefully we

can get an exception written in to the company's contract before I

have to resort to that.

My appeal went to the same place as yours did - San , but to

a different person - cross our fingers! We are keeping them busy

down there!

I will have to check out the ERISA website - thanks for the

additional info.

[Guest guest]

,

Double WOOOOOHOOOOOOO - that is wonderful news! Still crossing my

fingers over here - time is ticking away and I am getting a little

nervous. I just don't want to find out the day before - can't

really do much planning like that and I am a major planner. I guess

this weekend I will start shopping to get some of the things that I

may need, but don't want to get alot in case everything has to be

delayed and this is a long process.

I am so glad that we both have companies that are willing to help

out a bit - it makes it a bit easier to deal with and to get

somewhere. My company also contacted their insurance rep because

they are pretty concerned about this exclusion and the customer

service that they rec'd (horrible) Wonder what other kinds of

exclusions our policy has?

You are one step closer and got the worst part taken care of!

[Guest guest]

,

Double WOOOOOHOOOOOOO - that is wonderful news! Still crossing my

fingers over here - time is ticking away and I am getting a little

nervous. I just don't want to find out the day before - can't

really do much planning like that and I am a major planner. I guess

this weekend I will start shopping to get some of the things that I

may need, but don't want to get alot in case everything has to be

delayed and this is a long process.

I am so glad that we both have companies that are willing to help

out a bit - it makes it a bit easier to deal with and to get

somewhere. My company also contacted their insurance rep because

they are pretty concerned about this exclusion and the customer

service that they rec'd (horrible) Wonder what other kinds of

exclusions our policy has?

You are one step closer and got the worst part taken care of!

[Guest guest]

,

Double WOOOOOHOOOOOOO - that is wonderful news! Still crossing my

fingers over here - time is ticking away and I am getting a little

nervous. I just don't want to find out the day before - can't

really do much planning like that and I am a major planner. I guess

this weekend I will start shopping to get some of the things that I

may need, but don't want to get alot in case everything has to be

delayed and this is a long process.

I am so glad that we both have companies that are willing to help

out a bit - it makes it a bit easier to deal with and to get

somewhere. My company also contacted their insurance rep because

they are pretty concerned about this exclusion and the customer

service that they rec'd (horrible) Wonder what other kinds of

exclusions our policy has?

You are one step closer and got the worst part taken care of!