Re: Totally Confused with UHC

[Guest guest]

Join the club!

We're getting Geoffrey casted on Monday and UHC will not tell us

whether they're going to cover the band until after the procedure is

done and we have officially ordered the device! When we finally have

the casting and order it, THEN they will review the case.

Now I ask you.... what difference does it make if we submit the claim

just before we have him casted or just after we have him casted???

Wouldn't the criteria for covering or denying be the same? I've

decided that if they deny us I am going to go through my employer,

Wells Fargo, to fight them. Wells Fargo is a huge client of UHC and

I'm hoping they don't want to piss someone off at Wells.

About a year ago Wells Fargo was linked with the UHC center in Dallas,

Texas... they received so many complaints from Wells Fargo employees

about slow payment and non-coverage that Wells Fargo threatened to pull

their business from UHC... in response, UHC moved the Wells Fargo

clients to the processing center in Salt Lake City.

We'll see... They won't like messing with me. My father once got the

president of Eastern Airlines on the phone late at night (at his home).

I learned some tactics from him.

[Guest guest]

Now I ask you.... what difference does it make if we submit the claim just before we have him casted or just after we have him casted???

:

I would ask for this in writing!!!! It seems strange to me that you are being told to submit AFTER the casting, when most others have to wait for an official approval/denial before getting started (or they risk denial due to starting without approval). As many people here have learned, GET EVERYTHING IN WRITING. Write down who you talked to and when. Ask them to fax the statement to you NOW, or you will call back every 10 minutes until you receive it!

Kendra in Canadawww.plagiocephaly.org/support

----- Original Message -----

From:

Plagiocephaly

Sent: Friday, February 23, 2001 8:42 PM

Subject: Re: Totally Confused with UHC

Join the club! We're getting Geoffrey casted on Monday and UHC will not tell us whether they're going to cover the band until after the procedure is done and we have officially ordered the device! When we finally have the casting and order it, THEN they will review the case.Now I ask you.... what difference does it make if we submit the claim just before we have him casted or just after we have him casted??? Wouldn't the criteria for covering or denying be the same? I've decided that if they deny us I am going to go through my employer, Wells Fargo, to fight them. Wells Fargo is a huge client of UHC and I'm hoping they don't want to piss someone off at Wells.About a year ago Wells Fargo was linked with the UHC center in Dallas, Texas... they received so many complaints from Wells Fargo employees about slow payment and non-coverage that Wells Fargo threatened to pull their business from UHC... in response, UHC moved the Wells Fargo clients to the processing center in Salt Lake City.We'll see... They won't like messing with me. My father once got the president of Eastern Airlines on the phone late at night (at his home). I learned some tactics from him.

[Guest guest]

Hey we are with UHC too! Becky

[Guest guest]

We are POS I wonder if that makes any difference with getting coverage. Keep us posted as to how it goes. Thanks and good luck. Becky

[Guest guest]

Actually it was the Orhotist's office who called submitted in advance

-- I never actually talked to UHC. It was the orthotist himself who

was told they would not review the case until after casting.

We go in for casting on Monday morning, so it's moot at this point.

We'll be submitting a claim that day. I did notice there were a

couple people on the insurance database (on this board) who were had

UHC and they paid some or all of it. So there must be precident.

> Now I ask you.... what difference does it make if we submit the

claim

> just before we have him casted or just after we have him casted???

> :

> I would ask for this in writing!!!! It seems strange to me that you

are being told to submit AFTER the casting, when most others have to

wait for an official approval/denial before getting started (or they

risk denial due to starting without approval). As many people here

have learned, GET EVERYTHING IN WRITING. Write down who you talked to

and when. Ask them to fax the statement to you NOW, or you will call

back every 10 minutes until you receive it!

> Kendra in Canada

> www.plagiocephaly.org/support

[Guest guest]

Yeah we have UHC PPO... Other than having to get them to pay for some

lab work, I've been *fairly* satisfied with them up to this point.

Their coverage or denial of Geoffrey's band will either make my

opinion of them better or much worse.

> Hey we are with UHC too!

> Becky

[Guest guest]

:

All I can say is that with some insurance companies until you get the denial

or approval for the treatment they consider you going ahead without

" following procedures " -- and then may end up denying you for this reason,

and this is the hardest reason for denial to fight. If they have told you

that they will not make a decision to approve or not until after the

casting -- GET IT IN WRITING -- and have it faxed to you.

H.

-----Original Message-----

From: [mailto:paulbrunell@...]

Sent: Saturday, February 24, 2001 12:22 PM

Plagiocephaly

Subject: Re: Totally Confused with UHC

Actually it was the Orhotist's office who called submitted in advance

-- I never actually talked to UHC. It was the orthotist himself who

was told they would not review the case until after casting.

We go in for casting on Monday morning, so it's moot at this point.

We'll be submitting a claim that day. I did notice there were a

couple people on the insurance database (on this board) who were had

UHC and they paid some or all of it. So there must be precident.

> Now I ask you.... what difference does it make if we submit the

claim

> just before we have him casted or just after we have him casted???

> :

> I would ask for this in writing!!!! It seems strange to me that you

are being told to submit AFTER the casting, when most others have to

wait for an official approval/denial before getting started (or they

risk denial due to starting without approval). As many people here

have learned, GET EVERYTHING IN WRITING. Write down who you talked to

and when. Ask them to fax the statement to you NOW, or you will call

back every 10 minutes until you receive it!

> Kendra in Canada

> www.plagiocephaly.org/support

[Guest guest]

We, too, have UHC PPO, and up until now, I have been pretty happy with

them and have had no problems with any sort of coverage except pharmacy

stuff. Unfortunately, I cannot go to the HR dept. of my husband's

company for more assistance, as my husband and I own the company and I

am the "HR dept" as I picked the carrier and plan, etc. We have

12 employees and their dependents covered by UHC and as far as I know,

other than some prescription coverage. B/c we are a small group (under

50 employees) we pay really high premiums--and their not paying for the

headband really chaps me. CT suggested I file a complaint with the

TX Dept of Insurance, which I think I may do.

wrote:

Yeah we have UHC PPO... Other than having to

get them to pay for some

lab work, I've been *fairly* satisfied with them up to this point.

Their coverage or denial of Geoffrey's band will either make my

opinion of them better or much worse.

> Hey we are with UHC too!

> Becky

[Guest guest]

Hi Jaya-

we just got diagnosed by our ped-and have the neuro consult this Wednesday the 28th. Our ped-pre-warned us that we will likely not get covered but I plan to fight that. I will keep you posted. Becky

[Guest guest]

Becky,

I mentioned in my previous post that we found out on Thursday that

another family in the same office that has UHC got pre-approval for

the band no problem. The plan that they have is also a

POS..............we have the PPO.

I honestly don't know what UHC's criteria is and why the cover some

and not others........the whole thing seems pretty shady to me!

Did you get covered? Or are you still waiting to hear?

Sincerely,

Jaya Dong

> We are POS I wonder if that makes any difference with getting

coverage. Keep

> us posted as to how it goes. Thanks and good luck. Becky

[Guest guest]

:

I think filing a complaint with the Department of Insurance is a good idea.

It gets a lot of things straightened out and gets the ball rolling a lot

faster than it might otherwise! I would suggest that to just about anyone

having trouble with their insurance company. If you have an HMO you will need

to check your state regulations - we have to file complaints against HMOs

with the State Dept. of Health rather than the Dept of Insurance!

Good Luck!!

Marci (Mom to )

Oklahoma

[Guest guest]

Marci--

I have a PPO--so do I file with the Dept. of Ins. or Health?? What do you

suggest I send to them?? Just a letter, or copies of my appeals stuff that I

turned in to United??

marcisch@... wrote:

> :

>

> I think filing a complaint with the Department of Insurance is a good idea.

> It gets a lot of things straightened out and gets the ball rolling a lot

> faster than it might otherwise! I would suggest that to just about anyone

> having trouble with their insurance company. If you have an HMO you will need

> to check your state regulations - we have to file complaints against HMOs

> with the State Dept. of Health rather than the Dept of Insurance!

>

> Good Luck!!

>

> Marci (Mom to )

> Oklahoma

>

>