United HealthCare

[Guest guest]

I just got my approval letter, but only to find out that the doctor I spoke

to isn't on the plan. I can't afford the out of pocket.

Does anyone know a good dr. covered by United HealthCare?

[Guest guest]

I had the same trouble and denial with United Healthcare. My doctor

told me about a leagl statute that makes it illegal to deny based on

descriminating against a joint or bone (ie: Jaw), if they cover

other joints or bones - which they of course do! It depends what

state you live in , as not all states have these types of statutes.

Search the web for yours, I live in Florida - I copied the statute

below for your reference.

I found mine in about 5 minutes.

PS: I am 5 weeks post-op for upper jaw expansion and brought

forward, everything is fine. So far United has been billed a total

of $39,000 for hospital and surgeons, and I have only had to pay a

couple hundred in co-pays.

Good luck, read below.....

" The 2003 Florida Statutes

Title XXXVII

INSURANCE Chapter 641

HEALTH CARE SERVICE PROGRAMS View Entire Chapter

641.31094 Nondiscrimination of coverage for certain surgical

procedures involving bones or joints.--No health maintenance

contract or policy which provides coverage for any diagnostic or

surgical procedure involving bones or joints of the skeleton shall

discriminate against coverage for any similar diagnostic or surgical

procedure involving bones or joints of the jaw and facial region,

if, under accepted medical standards, such procedure or surgery is

medically necessary to treat conditions caused by congenital or

developmental deformity, disease, or injury. This section shall not

be construed to affect any other coverage under this part or to

restrict the scope of coverage under any policy, plan, or contract.

Nothing in this section shall be construed to discourage appropriate

nonsurgical procedures or to prohibit the continued coverage of

nonsurgical procedures in the treatment of a bone or joint of the

jaw and facial region. Furthermore, nothing in this subsection

requires coverage for care or treatment of the teeth or gums, for

intraoral prosthetic devices, or for surgical procedures for

cosmetic purposes. "

> I was denied coverage under my health plan and I appealed it.

Well

> in my denial letter to me, they said that " When we receive this

> information, we will complete our review no later than 15 calendar

> days after we receive your request for review. " Well I sent the

> appeal letter on Feb 5 to San and they received it Feb.

9.

> So I called them today to get an update. Apparently San

> sends it to Greensboro, NC! I asked why couldn't I just have sent

it

> to Greensboro. She didn't have an answer. Well Greensboro

received

> it on Feb 18 and the 15 day review would be March 4. She told me

to

> call back in 30-45 days and see if there is a decision. I said

well

> it says in my letter that they will make a decision in 15 days of

> receipt of letter, why should I wait 30-45? She was silent and

put

> me on hold and when she came back she told me to call back in 30-

45

> days. Why do they say that they'll complete their review in 15

days

> and then tell me to call back in 30-45? Isn't this wrong to do?

I

> will call them on March 5 and go through it all again. This is

> wrong! Has anybody else had this saying in their denial letter

from

> United Healthcare? Sorry, I'm venting. Thanks for listening.

Also,

> do I have to wait until the final denial before I can go to the

State

> Insurance Commission? I want to send them a letter explaining

that

> United Healthcare is giving me the run-around.