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United Health care - Formula Coverage - Please respond if you have UHC

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  • lawblond7@AOL.COM
    I am looking for anyone who has United Health Care (a fully funded plan and not a self insured plan) - that has gotten United Health Care to pay for formula.
    Message 1 of 5 , Dec 1, 2007
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      I am looking for anyone who has United Health Care (a fully funded plan and not a self insured plan) - that has gotten United Health Care to pay for formula.  They claim the COC  (Certificate of coverage) denies formula coverage under any and all circumstances and it is not based on medical necessity - seems to me this is solely a cost cutting measure. Under this rationale and this seems to be their thinking - they will deny coverage even when formula is the treatment for a disorder such as PKU. For 2 of my boys who are tube fed - the formula - Elecare - is life sustaining and medically necessary.  I want to know if anyone has fought them under a fully funded plan and won and how  you did it.
       
      I am in the process of compiling a package to send to all the local media outlets in the DC area plus the Washington Post and also to local congressmen and Senators and I have someone who can get it into the Governor's hands directly.  Also going to the insurance commission.  They did state they would not deny a diabetic insulin or a hemophelia blood but ok to deny my child life sustaining formula.  Interesting thing they cover all the g-tube supplies and bags. We are to start with them in January and I plan to make their life a living hell before then.  Please either respond to list or off list if you prefer to lawblond7@...
       
      If it matters I live in Maryland and the company I am employed with the office is in Northern Virginia.

      Hugs Sharon
       mom to 3 wonderful boys all with mito - Jake (14 - gifted, ADHD and associated mood disorder, eos, kidney stones, g-tube allergic to milk, peanuts, latex, white potatoes and tomatoes...on Concerta, Ripseral. ritalin, sodium bicard, prevacid, clonidine, mito cocktail), Cole (10 - Clay's twin, ADD and migraines and probable eos...on Concerta and periactin and Clay (10 - ADHD, platelet dsyfunction, PDD, Epilepsy (Seizures), eos, allergic to latex, shellfish, peanuts ----on and on - and he is taking Daytrana, Trileptal and mito cokctail) 
      www.caringbridge.org/visit/jakeski        www.caringbridge.org/visit/claytonandcole







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    • Jennifer McKay
      We didn t fight them on covering formula, but put up one hell of a fight for nursing coverage. The hospital helped a whole bunch and made calls to big wigs in
      Message 2 of 5 , Dec 1, 2007
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        We didn’t fight them on covering formula, but put up one hell of a fight for nursing coverage. The hospital helped a whole bunch and made calls to big wigs in the company for us stating that they would not allow us to go home without it so either they paid for us to stay in the hospital or they paid for nursing until we got onto Medicaid. Coming from you you’re not going to get very far, but if your doctor can and is willing to fight with them and makes it about money – as in they cover the formula or they have to pay a whole lot more for other treatments and hospital stays that should work.

         

        Jennifer

         

        James (Jimmy) 11/2/06 – undiagnosed mitochondrial disorder, undiagnosed neurological movements, cataracts (since removed and now wearing contacts), developmental delays, hypotonia, g-button with nissen due to reflux, trach due to laryngomalasia, hiatal hernia, brain atrophy (1-2mm in comparison to ventricles), and seizures

        www.myspace.com/jrmckay

         

        Thomas Alva Edison - I haven't failed. I've just found 10,000 ways that won't work. (on inventing the light bulb)

         


        From: Mito@yahoogroups.com [mailto: Mito@yahoogroups.com ] On Behalf Of lawblond7@...
        Sent: Saturday, December 01, 2007 7:02 AM
        To: undisclosed-recipients:
        Subject: [ Mito ] United Health care - Formula Coverage - Please respond if you have UHC

         

        I am looking for anyone who has United Health Care (a fully funded plan and not a self insured plan) - that has gotten United Health Care to pay for formula.  They claim the COC  (Certificate of coverage) denies formula coverage under any and all circumstances and it is not based on medical necessity - seems to me this is solely a cost cutting measure. Under this rationale and this seems to be their thinking - they will deny coverage even when formula is the treatment for a disorder such as PKU. For 2 of my boys who are tube fed - the formula - Elecare - is life sustaining and medically necessary.  I want to know if anyone has fought them under a fully funded plan and won and how  you did it.

         

        I am in the process of compiling a package to send to all the local media outlets in the DC area plus the Washington Post and also to local congressmen and Senators and I have someone who can get it into the Governor's hands directly.  Also going to the insurance commission.  They did state they would not deny a diabetic insulin or a hemophelia blood but ok to deny my child life sustaining formula.  Interesting thing they cover all the g-tube supplies and bags. We are to start with them in January and I plan to make their life a living hell before then.  Please either respond to list or off list if you prefer to lawblond7@aol. com

         

        If it matters I live in Maryland and the company I am employed with the office is in Northern Virginia .

        Hugs Sharon
         mom to 3 wonderful boys all with mito - Jake (14 - gifted, ADHD and associated mood disorder, eos, kidney stones, g-tube allergic to milk, peanuts, latex, white potatoes and tomatoes...on Concerta, Ripseral. ritalin, sodium bicard, prevacid, clonidine, mito cocktail), Cole (10 - Clay's twin, ADD and migraines and probable eos...on Concerta and periactin and Clay (10 - ADHD, platelet dsyfunction, PDD, Epilepsy (Seizures), eos, allergic to latex, shellfish, peanuts ----on and on - and he is taking Daytrana, Trileptal and mito cokctail) 
        www.caringbridge. org/visit/ jakeski        www.caringbridge. org/visit/ claytonandcole





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      • Sue Ann Bube
        Find out what state United Health Care operates under. Most states have a Metabolic exemption in the state laws that insurance companies have to abide by
        Message 3 of 5 , Dec 1, 2007
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          Find out what state United Health Care operates under. Most states have a Metabolic exemption in the state laws that insurance companies have to abide by especially for kids with PKU but depending on how the law is written in that state it could cover other metabolic issues as well. I got Private Health Insurance to cover my son at 100% because of the state laws.

           

          Sue Ann Bube

          (C) 253.737.0207


          From: Mito@yahoogroups.com [mailto: Mito@yahoogroups.com ] On Behalf Of lawblond7@...
          Sent: Saturday, December 01, 2007 5:02 AM
          To: undisclosed-recipients:
          Subject: [ Mito ] United Health care - Formula Coverage - Please respond if you have UHC

           

          I am looking for anyone who has United Health Care (a fully funded plan and not a self insured plan) - that has gotten United Health Care to pay for formula.  They claim the COC  (Certificate of coverage) denies formula coverage under any and all circumstances and it is not based on medical necessity - seems to me this is solely a cost cutting measure. Under this rationale and this seems to be their thinking - they will deny coverage even when formula is the treatment for a disorder such as PKU. For 2 of my boys who are tube fed - the formula - Elecare - is life sustaining and medically necessary.  I want to know if anyone has fought them under a fully funded plan and won and how  you did it.

           

          I am in the process of compiling a package to send to all the local media outlets in the DC area plus the Washington Post and also to local congressmen and Senators and I have someone who can get it into the Governor's hands directly.  Also going to the insurance commission.  They did state they would not deny a diabetic insulin or a hemophelia blood but ok to deny my child life sustaining formula.  Interesting thing they cover all the g-tube supplies and bags. We are to start with them in January and I plan to make their life a living hell before then.  Please either respond to list or off list if you prefer to lawblond7@aol. com

           

          If it matters I live in Maryland and the company I am employed with the office is in Northern Virginia .

          Hugs Sharon
           mom to 3 wonderful boys all with mito - Jake (14 - gifted, ADHD and associated mood disorder, eos, kidney stones, g-tube allergic to milk, peanuts, latex, white potatoes and tomatoes...on Concerta, Ripseral. ritalin, sodium bicard, prevacid, clonidine, mito cocktail), Cole (10 - Clay's twin, ADD and migraines and probable eos...on Concerta and periactin and Clay (10 - ADHD, platelet dsyfunction, PDD, Epilepsy (Seizures), eos, allergic to latex, shellfish, peanuts ----on and on - and he is taking Daytrana, Trileptal and mito cokctail) 
          www.caringbridge. org/visit/ jakeski        www.caringbridge. org/visit/ claytonandcole





          Check out AOL Money Finance's list of the hottest products and top money wasters of 2007.

        • Laura Fant
          We had formula coverage for tube and oral feedings while we had UHC. My son doesn t have PKU. We got a copy of their clinical policy guidelines and it was
          Message 4 of 5 , Dec 1, 2007
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            We had formula coverage for tube and oral feedings while we had UHC. My son doesn't have PKU. We got a copy of their clinical policy guidelines and it was covered. I am looking in my files for it for you. Try searching this site. It wasn't working for me right now but may in a bit.
            https://www.unitedhealthcareonline.com/b2c/CmaAction.do?channelId=cdc94e74bc62c010VgnVCM100000c520720a____

            ________________________________

            From: Mito@yahoogroups.com on behalf of lawblond7@...
            Sent: Sat 12/1/2007 8:01 AM
            To: undisclosed-recipients
            Subject: [Mito] United Health care - Formula Coverage - Please respond if you have UHC



            I am looking for anyone who has United Health Care (a fully funded plan and not a self insured plan) - that has gotten United Health Care to pay for formula. They claim the COC (Certificate of coverage) denies formula coverage under any and all circumstances and it is not based on medical necessity - seems to me this is solely a cost cutting measure. Under this rationale and this seems to be their thinking - they will deny coverage even when formula is the treatment for a disorder such as PKU. For 2 of my boys who are tube fed - the formula - Elecare - is life sustaining and medically necessary. I want to know if anyone has fought them under a fully funded plan and won and how you did it.

            I am in the process of compiling a package to send to all the local media outlets in the DC area plus the Washington Post and also to local congressmen and Senators and I have someone who can get it into the Governor's hands directly. Also going to the insurance commission. They did state they would not deny a diabetic insulin or a hemophelia blood but ok to deny my child life sustaining formula. Interesting thing they cover all the g-tube supplies and bags. We are to start with them in January and I plan to make their life a living hell before then. Please either respond to list or off list if you prefer to lawblond7@... <mailto:lawblond7@...>

            If it matters I live in Maryland and the company I am employed with the office is in Northern Virginia.

            Hugs Sharon
            mom to 3 wonderful boys all with mito - Jake (14 - gifted, ADHD and associated mood disorder, eos, kidney stones, g-tube allergic to milk, peanuts, latex, white potatoes and tomatoes...on Concerta, Ripseral. ritalin, sodium bicard, prevacid, clonidine, mito cocktail), Cole (10 - Clay's twin, ADD and migraines and probable eos...on Concerta and periactin and Clay (10 - ADHD, platelet dsyfunction, PDD, Epilepsy (Seizures), eos, allergic to latex, shellfish, peanuts ----on and on - and he is taking Daytrana, Trileptal and mito cokctail)
            www.caringbridge.org/visit/jakeski <http://www.caringbridge.org/visit/jakeski> www.caringbridge.org/visit/claytonandcole <http://www.caringbridge.org/visit/claytonandcole>







            ________________________________

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          • Gracie
            I had to order through MEDCO the UHC pharmacy a 3 month supply was $60 but then they wouldn t do it due to Ex not paying the back balance on the insurance so
            Message 5 of 5 , Dec 1, 2007
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              I had to order through MEDCO the UHC pharmacy a 3 month supply was $60 but then they wouldn't do it due to Ex not paying the back balance on the insurance so we had to go through Medicaid the social worker at the hospital will help you obtain coverage have you tried to get a secondary insurance like Medicaid or BCMH?
               
              GracieAnn
              ----- Original Message -----
              To: undisclosed-recipients
              Sent: Saturday, December 01, 2007 8:01 AM
              Subject: [Mito] United Health care - Formula Coverage - Please respond if you have UHC

              I am looking for anyone who has United Health Care (a fully funded plan and not a self insured plan) - that has gotten United Health Care to pay for formula.  They claim the COC  (Certificate of coverage) denies formula coverage under any and all circumstances and it is not based on medical necessity - seems to me this is solely a cost cutting measure. Under this rationale and this seems to be their thinking - they will deny coverage even when formula is the treatment for a disorder such as PKU. For 2 of my boys who are tube fed - the formula - Elecare - is life sustaining and medically necessary.  I want to know if anyone has fought them under a fully funded plan and won and how  you did it.
               
              I am in the process of compiling a package to send to all the local media outlets in the DC area plus the Washington Post and also to local congressmen and Senators and I have someone who can get it into the Governor's hands directly.  Also going to the insurance commission.  They did state they would not deny a diabetic insulin or a hemophelia blood but ok to deny my child life sustaining formula.  Interesting thing they cover all the g-tube supplies and bags. We are to start with them in January and I plan to make their life a living hell before then.  Please either respond to list or off list if you prefer to lawblond7@aol. com
               
              If it matters I live in Maryland and the company I am employed with the office is in Northern Virginia.

              Hugs Sharon
               mom to 3 wonderful boys all with mito - Jake (14 - gifted, ADHD and associated mood disorder, eos, kidney stones, g-tube allergic to milk, peanuts, latex, white potatoes and tomatoes...on Concerta, Ripseral. ritalin, sodium bicard, prevacid, clonidine, mito cocktail), Cole (10 - Clay's twin, ADD and migraines and probable eos...on Concerta and periactin and Clay (10 - ADHD, platelet dsyfunction, PDD, Epilepsy (Seizures), eos, allergic to latex, shellfish, peanuts ----on and on - and he is taking Daytrana, Trileptal and mito cokctail) 
              www.caringbridge. org/visit/ jakeski        www.caringbridge. org/visit/ claytonandcole







              Check out AOL Money Finance's list of the hottest products and top money wasters of 2007.

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