Fwd: Denied insurance...help needed in NY!

[Guest guest]

So, after waiting a few weeks, my oral surgeon's office finally got

the bad news from United Healthcare, that they denied my pre-

certification for surgery, saying that it is not covered by my

policy. So I called to get the scoop, and UHC said that " Dental

surgery is not covered unless from the result of an accident or

birth defect. " Well, at that point I laughed and told the UHC rep

that this is MOST CERTAINLY NOT DENTAL SURGERY. I told her that (1)

this is indeed medical (evidenced by the " Medical Necessity Letter "

sent from my doctors office) and (2) the doctor will not even touch

one tooth, merely cut jaws.

Here's my quick background, as I haven't posted in a while. I am

scheduled for upper & lower surgery on March 8th. I had a SARPE in

June 2003, which surprisingly enough, UHC DID COVER...hmmm! How can

they cover the SARPE surgery and actual device and not the surgery

for which the SARPE was required?

So, I then asked UHC for a copy of my complete policy (including all

details of what is and is not covered). I was told that NO

such " book " exists and that they would read anything to me from the

database...no emails, no faxes, no details online, nothing. I was

furious...I mean, how is it that I pay premiums EVERY month, and

cannot get a copy of my policy (which I believe my employer does not

even have...but I have to do more investigating on that end).

After this lovely phone call, I called the Dr. office back and as it

turns out, my surgeon is unfortunately out of town until next

Monday, so I will have to wait. So I spoke a bit with his assistant,

and she further told me that when she submitted for approval, she

had the package all ready to go, including x-rays, models, forms,

etc. BUT, UHC only wanted stuff faxed and said they didn't need the

the x-rays and models. I laughed at that, thinking " of course, why

would they want models and x-rays when they're just going to deny me

on the 1st try. "

Not sure if any of you remember the book/movie, " The Rainmaker " ,

where Matt Damon defended a kid who died of lukemia, all b/s the

insurance company wouldn't pay for his treatment. Then in the movie,

it's disclosed that the insurance rep manual specifically states to

deny, deny, deny...and eventually the people will go away.

Well, this is sort of how I feel. I guess I'll have to wait till my

doctor returns in order to start the appeal. But in the meantime,

I'm planning to get letteres from my orth, and all 2nd, 3rd opinion

doctors supporting the medical necessity and supporting that this is

indeed a medical surgery.

Any help, ideas, thoughts would be greatly appreciated. Thanks for

all the support.

-

--- End forwarded message ---

[Guest guest]

,

Look up message 73158. I had the same problem with United (they had

exclusion). Hopefully you can do in New York what I had in Florida,

give it a try.

> So, after waiting a few weeks, my oral surgeon's office finally

got

> the bad news from United Healthcare, that they denied my pre-

> certification for surgery, saying that it is not covered by my

> policy. So I called to get the scoop, and UHC said that " Dental

> surgery is not covered unless from the result of an accident or

> birth defect. " Well, at that point I laughed and told the UHC rep

> that this is MOST CERTAINLY NOT DENTAL SURGERY. I told her that

(1)

> this is indeed medical (evidenced by the " Medical Necessity

Letter "

> sent from my doctors office) and (2) the doctor will not even

touch

> one tooth, merely cut jaws.

>

> Here's my quick background, as I haven't posted in a while. I am

> scheduled for upper & lower surgery on March 8th. I had a SARPE in

> June 2003, which surprisingly enough, UHC DID COVER...hmmm! How

can

> they cover the SARPE surgery and actual device and not the surgery

> for which the SARPE was required?

>

> So, I then asked UHC for a copy of my complete policy (including

all

> details of what is and is not covered). I was told that NO

> such " book " exists and that they would read anything to me from

the

> database...no emails, no faxes, no details online, nothing. I was

> furious...I mean, how is it that I pay premiums EVERY month, and

> cannot get a copy of my policy (which I believe my employer does

not

> even have...but I have to do more investigating on that end).

>

> After this lovely phone call, I called the Dr. office back and as

it

> turns out, my surgeon is unfortunately out of town until next

> Monday, so I will have to wait. So I spoke a bit with his

assistant,

> and she further told me that when she submitted for approval, she

> had the package all ready to go, including x-rays, models, forms,

> etc. BUT, UHC only wanted stuff faxed and said they didn't need

the

> the x-rays and models. I laughed at that, thinking " of course, why

> would they want models and x-rays when they're just going to deny

me

> on the 1st try. "

>

> Not sure if any of you remember the book/movie, " The Rainmaker " ,

> where Matt Damon defended a kid who died of lukemia, all b/s the

> insurance company wouldn't pay for his treatment. Then in the

movie,

> it's disclosed that the insurance rep manual specifically states

to

> deny, deny, deny...and eventually the people will go away.

>

> Well, this is sort of how I feel. I guess I'll have to wait till

my

> doctor returns in order to start the appeal. But in the meantime,

> I'm planning to get letteres from my orth, and all 2nd, 3rd

opinion

> doctors supporting the medical necessity and supporting that this

is

> indeed a medical surgery.

>

> Any help, ideas, thoughts would be greatly appreciated. Thanks for

> all the support.

>

> -

> --- End forwarded message ---

[Guest guest]

,

Look up message 73158. I had the same problem with United (they had

exclusion). Hopefully you can do in New York what I had in Florida,

give it a try.

> So, after waiting a few weeks, my oral surgeon's office finally

got

> the bad news from United Healthcare, that they denied my pre-

> certification for surgery, saying that it is not covered by my

> policy. So I called to get the scoop, and UHC said that " Dental

> surgery is not covered unless from the result of an accident or

> birth defect. " Well, at that point I laughed and told the UHC rep

> that this is MOST CERTAINLY NOT DENTAL SURGERY. I told her that

(1)

> this is indeed medical (evidenced by the " Medical Necessity

Letter "

> sent from my doctors office) and (2) the doctor will not even

touch

> one tooth, merely cut jaws.

>

> Here's my quick background, as I haven't posted in a while. I am

> scheduled for upper & lower surgery on March 8th. I had a SARPE in

> June 2003, which surprisingly enough, UHC DID COVER...hmmm! How

can

> they cover the SARPE surgery and actual device and not the surgery

> for which the SARPE was required?

>

> So, I then asked UHC for a copy of my complete policy (including

all

> details of what is and is not covered). I was told that NO

> such " book " exists and that they would read anything to me from

the

> database...no emails, no faxes, no details online, nothing. I was

> furious...I mean, how is it that I pay premiums EVERY month, and

> cannot get a copy of my policy (which I believe my employer does

not

> even have...but I have to do more investigating on that end).

>

> After this lovely phone call, I called the Dr. office back and as

it

> turns out, my surgeon is unfortunately out of town until next

> Monday, so I will have to wait. So I spoke a bit with his

assistant,

> and she further told me that when she submitted for approval, she

> had the package all ready to go, including x-rays, models, forms,

> etc. BUT, UHC only wanted stuff faxed and said they didn't need

the

> the x-rays and models. I laughed at that, thinking " of course, why

> would they want models and x-rays when they're just going to deny

me

> on the 1st try. "

>

> Not sure if any of you remember the book/movie, " The Rainmaker " ,

> where Matt Damon defended a kid who died of lukemia, all b/s the

> insurance company wouldn't pay for his treatment. Then in the

movie,

> it's disclosed that the insurance rep manual specifically states

to

> deny, deny, deny...and eventually the people will go away.

>

> Well, this is sort of how I feel. I guess I'll have to wait till

my

> doctor returns in order to start the appeal. But in the meantime,

> I'm planning to get letteres from my orth, and all 2nd, 3rd

opinion

> doctors supporting the medical necessity and supporting that this

is

> indeed a medical surgery.

>

> Any help, ideas, thoughts would be greatly appreciated. Thanks for

> all the support.

>

> -

> --- End forwarded message ---

[Guest guest]

,

Look up message 73158. I had the same problem with United (they had

exclusion). Hopefully you can do in New York what I had in Florida,

give it a try.

> So, after waiting a few weeks, my oral surgeon's office finally

got

> the bad news from United Healthcare, that they denied my pre-

> certification for surgery, saying that it is not covered by my

> policy. So I called to get the scoop, and UHC said that " Dental

> surgery is not covered unless from the result of an accident or

> birth defect. " Well, at that point I laughed and told the UHC rep

> that this is MOST CERTAINLY NOT DENTAL SURGERY. I told her that

(1)

> this is indeed medical (evidenced by the " Medical Necessity

Letter "

> sent from my doctors office) and (2) the doctor will not even

touch

> one tooth, merely cut jaws.

>

> Here's my quick background, as I haven't posted in a while. I am

> scheduled for upper & lower surgery on March 8th. I had a SARPE in

> June 2003, which surprisingly enough, UHC DID COVER...hmmm! How

can

> they cover the SARPE surgery and actual device and not the surgery

> for which the SARPE was required?

>

> So, I then asked UHC for a copy of my complete policy (including

all

> details of what is and is not covered). I was told that NO

> such " book " exists and that they would read anything to me from

the

> database...no emails, no faxes, no details online, nothing. I was

> furious...I mean, how is it that I pay premiums EVERY month, and

> cannot get a copy of my policy (which I believe my employer does

not

> even have...but I have to do more investigating on that end).

>

> After this lovely phone call, I called the Dr. office back and as

it

> turns out, my surgeon is unfortunately out of town until next

> Monday, so I will have to wait. So I spoke a bit with his

assistant,

> and she further told me that when she submitted for approval, she

> had the package all ready to go, including x-rays, models, forms,

> etc. BUT, UHC only wanted stuff faxed and said they didn't need

the

> the x-rays and models. I laughed at that, thinking " of course, why

> would they want models and x-rays when they're just going to deny

me

> on the 1st try. "

>

> Not sure if any of you remember the book/movie, " The Rainmaker " ,

> where Matt Damon defended a kid who died of lukemia, all b/s the

> insurance company wouldn't pay for his treatment. Then in the

movie,

> it's disclosed that the insurance rep manual specifically states

to

> deny, deny, deny...and eventually the people will go away.

>

> Well, this is sort of how I feel. I guess I'll have to wait till

my

> doctor returns in order to start the appeal. But in the meantime,

> I'm planning to get letteres from my orth, and all 2nd, 3rd

opinion

> doctors supporting the medical necessity and supporting that this

is

> indeed a medical surgery.

>

> Any help, ideas, thoughts would be greatly appreciated. Thanks for

> all the support.

>

> -

> --- End forwarded message ---