Re: United Healthcare insurance appeal

[Guest guest]

I have received my initial rejection from United Healthcare for resurfacing. (It

was submitted by JRI.) Does anyone have suggestions on how to be most effective

in my appeal?

,I wrote a long letter addressing the possible lifetime costs that the

insurance company would likely pay in the event that they refused the

resurfacing in favor of a total hip. I explained the likely need for revisions,

and the possibility for additional costs in the event of dislocations or other

problems. In my case, I was able to cite the history of a friend of mine who

had bilateral replacements and has had numerous dislocations (I think she is

well into the teens now) as well as revision surgeries. The insurance company

is in the business to make money. If you can convince them that this surgery

will likely save them money, they may well go for it. I believe UHC has

approved others before, so there is a precedence.

Best wishes to you on your appeal!

Cindy

C+ 5/25/01 and 6/28/01

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[Guest guest]

I have United Healthcare and my surgery was paid in full. I really don't

know why it varies from person to person/place to place.

[Guest guest]

>

> I have received my initial rejection from United Healthcare for

resurfacing. (It was submitted by JRI.) Does anyone have

suggestions on how to be most effective in my appeal?

>

> ,I wrote a long letter addressing the possible lifetime costs

that the insurance company would likely pay in the event that they

refused the resurfacing in favor of a total hip. I explained the

likely need for revisions, and the possibility for additional costs

in the event of dislocations or other problems. In my case, I was

able to cite the history of a friend of mine who had bilateral

replacements and has had numerous dislocations (I think she is well

into the teens now) as well as revision surgeries. The insurance

company is in the business to make money. If you can convince them

that this surgery will likely save them money, they may well go for

it. I believe UHC has approved others before, so there is a

precedence.

>

> Best wishes to you on your appeal!

>

> Cindy

> C+ 5/25/01 and 6/28/01

>

> _______________________________________________

>

>

>

>

[Guest guest]

,

I too have recieved my denial letter. I have sent off my 1st appeal

letter with the help from this web sites members. I will let you

know how it turns out sometime near the end of this month.

Mike

> >

> > I have received my initial rejection from United Healthcare for

> resurfacing. (It was submitted by JRI.) Does anyone have

> suggestions on how to be most effective in my appeal?

> >

> > ,I wrote a long letter addressing the possible lifetime

costs

> that the insurance company would likely pay in the event that they

> refused the resurfacing in favor of a total hip. I explained the

> likely need for revisions, and the possibility for additional

costs

> in the event of dislocations or other problems. In my case, I was

> able to cite the history of a friend of mine who had bilateral

> replacements and has had numerous dislocations (I think she is

well

> into the teens now) as well as revision surgeries. The insurance

> company is in the business to make money. If you can convince

them

> that this surgery will likely save them money, they may well go

for

> it. I believe UHC has approved others before, so there is a

> precedence.

> >

> > Best wishes to you on your appeal!

> >

> > Cindy

> > C+ 5/25/01 and 6/28/01

> >

> > _______________________________________________

> >

> >

> >

> >

[Guest guest]

> I have United Healthcare and my surgery was paid in full. I really

don't

> know why it varies from person to person/place to place.

So was mine. And no problem whatsoever. I notice that many (most?)

of the insurance denials come when they were submitted by JRI. My

guess is that it's either the way that JRI submits the pre-approval

for the procedure to insurance, or something different about

California law.

I wonder if these folks would have far fewer problems with insurance

if they went out of California for their procedures. There are other

places within just a few hours flight(without even having to go out

of the country)where you can get it done, and quite nicely at that.

With the history on the rejections in CA that I've been seeing, I

think I would consider it if I lived there. For me, it would be

worth the traveling not to have to go through the aggravation of

fighting.

At least this board has all kinds of resources for rebuttal for those

who do get rejected. If I had been rejected, I was prepared.

Fortunately, I didn't need it.

This procedure is definitely worth fighting for, though.

Lois

Gross 8/6/03

[Guest guest]

I have United Healthcare and my surgery was paid in full. I really don't know

why it varies from person to person/place to place.

The plans may be different, state laws differ from place to place, different

people read the requests and either " rubber stamp " things or actually take the

time to read them, on and on and on... I know mine got rubber stamped with a

big old DENIED when my docs request was first issued.

Cindy

C+ 5/25/01 and 6/28/01

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