United Healthcare PPO services

[Guest guest]

I'm interested in undertaking orthognathic treatment to correct my

excessive vertical growth of my upper jaw, which is causing my loud

snoring, and is a detriment to my self-esteem. I wonder if United

Healthcare PPO is particularly good in covering this type of

procedure. Any information is welcomed. Much thanks.

[Guest guest]

My experience with UHC was absolutely horrible. I was covered under

their premium ppo program, and there was nothing premium about it.

They consistently lost my requests for pre-determinations, to the

point that I started to think it was deliberate. Seriously, they lost

both mail and faxed copies at least 6 times. They even lost a fedex

overnight delivery once (with my x-rays!), even though someone had

signed for it. I spent about a year trying to get a predetermination

from those idiots. Eventually they finally acknowledged receiving it,

then denied my request, and then when I tried appeal they went

through the whole lost-paperwork routine again for another 4 months.

My advice is to start a file, keep copies of everything, and *always*

call to verify that they received your paperwork. When they tell you

they haven't (and they will), ask for a supervisor and see if you can

fax the paperwork directly to the supervisor's personal attention.

Even after they say they've received your paperwork, call again the

next day and double-check with another rep, as sometimes your records

will be mysteriously lost even after they acknowledge receipt. You

should also closely track the progress of your request. My appeal was

bounced from Dept. A to Dept. B, where it sat for 2 weeks until I

called, then Dept. B said it wasn't the right department, so they

bounced it back to A, where it sat for weeks before I called again,

at which time they bounced it back to B, then back to A again....

--Neil

> I'm interested in undertaking orthognathic treatment to correct my

> excessive vertical growth of my upper jaw, which is causing my loud

> snoring, and is a detriment to my self-esteem. I wonder if United

> Healthcare PPO is particularly good in covering this type of

> procedure. Any information is welcomed. Much thanks.

[Guest guest]

Funny how everyone has a different story. I also have UHC PPO and

have had no problems at all! I did get a preapproval letter way

back before I even had them put my braces on. Then throughout the

next two years I kept contact with them letting them know I was

getting closer to my surgery date. I did have to resubmit for my

reapproval letter again 90 days prior to my surgery, but because

they had my file all set up (had x-rays/molds on file) I got an

approval in no time!

Neil had an excellent idea. Start a file immediately. Make it very

detailed as to who you spoke to and when. Request everything in

writing. My worst fear was that for some reason they would try to

deny my claim after I had gone through two years of orthodontics. I

kept in very close contact with the insurance contact at my surgeons

office and with the one at UHC. Get first and last names!!

Just today I called my hospital to see if any bills were outstanding

and they said all claims have been paid!

Good Luck!

Carol

> > I'm interested in undertaking orthognathic treatment to correct

my

> > excessive vertical growth of my upper jaw, which is causing my

loud

> > snoring, and is a detriment to my self-esteem. I wonder if

United

> > Healthcare PPO is particularly good in covering this type of

> > procedure. Any information is welcomed. Much thanks.

[Guest guest]

Neil.....

I had the exact same headache with UHC..... Hubby's company had so much

trouble with UHC they dropped them 1/1/03 after UHC had approved me finally

after an 8 month battle in 2001. Then when hubby's employer dropped UHC

ALLLLLLLL approvals were to be grandfathered over to Horizon BCBS of NJ.

well...... UHC conveniently forgot to send everyone's files to Horizon which

meant we had to start all over again with Horizon and all they had on my

file was the denied appeal letters from 2000!

Can you spell headaches????? I am so glad we have been keeping a paper trail

back from the original days of Horizon horrors since 2000.... Now we have

exhausted all appeals with Horizon and are in a company employee benefit

committee review. the last denied appeal had my surgeon extremely upset....

we even sent in sleep study results that recommended orthodontia and

orthgnathic surgery and they still denied the appeal!

Surgery is November 5 and we are getting financially ready (final stages) to

pay everyone their fees. Surgery will not be put off anymore.....

my advice..... a good sturdy paper trail and make the calls to be sure the

papers are received. Would you believe the benefit committee 30 page was

lost in the company's main office? A second 30 page report was hand

delivered!

good luck to anyone trying to get a pre-determination and fight the fight

last resort is always a lawyer but right now I want to be out of the

pain I have been living with all these years!

Carin

>From: chiefneil no_reply >

>Reply-To: orthognathicsurgerysupport

>To: orthognathicsurgerysupport

>Subject: [Orthognathic Surgery Support ] Re: United Healthcare PPO

>services

>Date: Mon, 22 Sep 2003 16:59:33 -0000

>

>My experience with UHC was absolutely horrible. I was covered under

>their premium ppo program, and there was nothing premium about it.

>They consistently lost my requests for pre-determinations, to the

>point that I started to think it was deliberate. Seriously, they lost

>both mail and faxed copies at least 6 times. They even lost a fedex

>overnight delivery once (with my x-rays!), even though someone had

>signed for it. I spent about a year trying to get a predetermination

>from those idiots. Eventually they finally acknowledged receiving it,

>then denied my request, and then when I tried appeal they went

>through the whole lost-paperwork routine again for another 4 months.

>

>My advice is to start a file, keep copies of everything, and *always*

>call to verify that they received your paperwork. When they tell you

>they haven't (and they will), ask for a supervisor and see if you can

>fax the paperwork directly to the supervisor's personal attention.

>Even after they say they've received your paperwork, call again the

>next day and double-check with another rep, as sometimes your records

>will be mysteriously lost even after they acknowledge receipt. You

>should also closely track the progress of your request. My appeal was

>bounced from Dept. A to Dept. B, where it sat for 2 weeks until I

>called, then Dept. B said it wasn't the right department, so they

>bounced it back to A, where it sat for weeks before I called again,

>at which time they bounced it back to B, then back to A again....

>

>--Neil

>

>

>

> > I'm interested in undertaking orthognathic treatment to correct my

> > excessive vertical growth of my upper jaw, which is causing my loud

> > snoring, and is a detriment to my self-esteem. I wonder if United

> > Healthcare PPO is particularly good in covering this type of

> > procedure. Any information is welcomed. Much thanks.

>

_________________________________________________________________

Frustrated with dial-up? Get high-speed for as low as $29.95/month

(depending on the local service providers in your area).

https://broadband.msn.com

[Guest guest]

Thanks for the replies guys, but how long ago you had your surgery

performed.

> I'm interested in undertaking orthognathic treatment to correct

my

> excessive vertical growth of my upper jaw, which is causing my

loud

> snoring, and is a detriment to my self-esteem. I wonder if United

> Healthcare PPO is particularly good in covering this type of

> procedure. Any information is welcomed. Much thanks.

[Guest guest]

Not particularly " good " by any means, but they did approve me

finally after a nice long fight! If you need any help - let me know!

-

> I'm interested in undertaking orthognathic treatment to correct

my

> excessive vertical growth of my upper jaw, which is causing my

loud

> snoring, and is a detriment to my self-esteem. I wonder if United

> Healthcare PPO is particularly good in covering this type of

> procedure. Any information is welcomed. Much thanks.

[Guest guest]

I have United Healthcare PPO and they are covering everything except my

genioplasty (chin) which they deemed cosmetic.

Sharon

United Healthcare PPO services

I'm interested in undertaking orthognathic treatment to correct my

excessive vertical growth of my upper jaw, which is causing my loud

snoring, and is a detriment to my self-esteem. I wonder if United

Healthcare PPO is particularly good in covering this type of

procedure. Any information is welcomed. Much thanks.

[Guest guest]

What kind of procedures were you getting btw besides genioplasty,

and did your surgeon mention orthognathic surgery on his

predetermination of benefits. Much thanks for the information.

> I have United Healthcare PPO and they are covering everything

except my genioplasty (chin) which they deemed cosmetic.

> Sharon

>

> United Healthcare PPO

services

>

>

> I'm interested in undertaking orthognathic treatment to correct

my

> excessive vertical growth of my upper jaw, which is causing my

loud

> snoring, and is a detriment to my self-esteem. I wonder if

United

> Healthcare PPO is particularly good in covering this type of

> procedure. Any information is welcomed. Much thanks.

>

>

>

[Guest guest]

I pulled my approval letter out and it says the following:

" The information submitted was reviewed by our MCR (Medical Claim Review) staff.

Based on their recommendation, we have determined that coverage is available for

Lefort I and mandibular osteotomy as follows:

CPT Code 21143 - Reconstruction midface, Lefort I; three or more pieces,

segment movement in any direction, without bone graft.

CPT Code 21193 - Reconstuction of mandibular rami, horizontal, vertical,

C, or L osteotomy; without bone graft. "

My case is unusual in that I intially had Empire Healthcare and had been

approved by them only after an appeal process at which time I submitted medical

support for surgery from my ENT, my primary care doctor, and a speech

pathologist. Then, my husband lost his job and I picked up our insurance

through my employer who carries UHC (NYS's Empire Plan). The Empire Plan uses

BCBS for hospital and UHC for medical. I still don't understand the difference

between the two. But anyway, when my paperwork was submitted to UHC they

approved it right away. They probably already had access to my approval from

Empire but I'm not really sure about that. I hope this helped.

Sharon

United Healthcare PPO

services

>

>

> I'm interested in undertaking orthognathic treatment to correct

my

> excessive vertical growth of my upper jaw, which is causing my

loud

> snoring, and is a detriment to my self-esteem. I wonder if

United

> Healthcare PPO is particularly good in covering this type of

> procedure. Any information is welcomed. Much thanks.

>

>

>

[Guest guest]

I forgot to mention one more thing...UHC DID lose my paperwork for a time

too...so it's definitely looking like their standard denial tactic! I would

never have gotten the approval letter from them if I had not called numerous

times (after three months of waiting) and demanded they FIND the paperwork. I

never had to resubmit the papers, though, so they obviously TURNED UP somewhere!

I was already half way through with my orthodontics and had already had my SARPE

surgery with Empire Healthcare, so there was no turning back for me even if it

was denied. I also had time to spare since my upper/lower jaw surgery was a

year away. Otherwise, I would have called UHC and hounded them sooner.

Sharon

United Healthcare PPO

services

>

>

> I'm interested in undertaking orthognathic treatment to correct

my

> excessive vertical growth of my upper jaw, which is causing my

loud

> snoring, and is a detriment to my self-esteem. I wonder if

United

> Healthcare PPO is particularly good in covering this type of

> procedure. Any information is welcomed. Much thanks.

>

>

>

[Guest guest]

My surgery is scheduled for November 5, 2003

Carin

>From: azninsomniac1982 no_reply >

>Reply-To: orthognathicsurgerysupport

>To: orthognathicsurgerysupport

>Subject: [Orthognathic Surgery Support ] Re: United Healthcare PPO

>services

>Date: Mon, 22 Sep 2003 21:48:41 -0000

>

>Thanks for the replies guys, but how long ago you had your surgery

>performed.

>

> > I'm interested in undertaking orthognathic treatment to correct

>my

> > excessive vertical growth of my upper jaw, which is causing my

>loud

> > snoring, and is a detriment to my self-esteem. I wonder if United

> > Healthcare PPO is particularly good in covering this type of

> > procedure. Any information is welcomed. Much thanks.

>

_________________________________________________________________

Frustrated with dial-up? Get high-speed for as low as $29.95/month

(depending on the local service providers in your area).

https://broadband.msn.com

[Guest guest]

You know, yet again I am reminded how grateful I should be to have

had a quick and easy approval on this stuff.

I am also reminded of the car salesmen who play such games as taking

customers' car keys and keeping them waiting on the lot to try to

have more time to sell them on a " deal. " I would never, on principle,

buy a car from any salesman who tried that gimmick, but I have had it

used on me.

Cammie