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Re: United Healthcare - Approval Letter Question

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  • kay88keys
    Steve, Tonia & Lisa - Thanks for writing. Guess I need to check into things more. I didn t mention in the message below that earlier I did get a denial
    Message 1 of 7 , Jun 1 4:00 AM
      Steve, Tonia & Lisa - Thanks for writing. Guess I need to check
      into things more. I didn't mention in the message below that
      earlier I did get a denial letter & then also got a letter that it
      went to appeals without my knowledge. Then I had trouble figuring
      out how to contact the appeals because they faxed it to another
      state, and nobody had the number. I got my HR person involved, who
      made calls & told me that United Healthcare told them they were
      going to pay for it. But I was concerned becauase the letter I
      mentioned below seemed kind of unclear. I still have a fear that
      it's in appeals without my knowledge.

      Sandra
      --- In orthognathicsurgerysupport@yahoogroups.com, lmont_2000
      <no_reply@y...> wrote:
      > Sandra,
      >
      > I had United Healthcare when I had my surgery three years ago and
      > they did send me a letter indicate what procedures they would
      cover.
      > The letter was fairly detailed and left no doubt in my mind about
      > what they would cover. You should have your doctor's office pursue
      > this and asked for a determination of benefits letter re: your
      > surgery. Good luck and God Bless.
      >
      > Kindly,
      > Lisa
      >
      >
      >
      > --- In orthognathicsurgerysupport@yahoogroups.com, kay88keys
      > <no_reply@y...> wrote:
      > > I'm trying to figure out if I really do have an approval letter
      > from
      > > United Healthcare or not (i.e. meaning they will pay for the
      > > surgery)??? What does an approval letter normally say exactly?
      > >
      > > My doctor's office sent in the paperwork for a
      predetermination.
      > > The letter I got back says that "we were told about the
      following
      > > outpatient procedure" & lists the procedure codes & goes on to
      say
      > > the expected date is 6/5/03 (in reality, I am at least 4-6
      months
      > > away from surgery). It says to call after the procedure if a
      > > hospital stay is required. Then it says "for eligibility or
      > benefit
      > > coverage, call the number on your card. Payment is based on
      terms
      > > of your benefit plan." At the top it has a "ref. num" which
      they
      > > told me on the phone was my authorization. I got the impression
      > on
      > > the phone that by getting this letter, it means they approve it
      &
      > > will pay for it. They said they can't issue this letter without
      a
      > > date, and the surgery has to be within 90 days of the letter for
      > it
      > > to be valid. My doctor's office said they sometimes give the
      > > insurance a "dummy surgery date" just to try to get the
      insurance
      > > company to take action & issue a letter. I guess I was
      expecting
      > > the letter to be more specific about saying they would pay for
      the
      > > procedure. Is this normally what insurance companies (&
      > > specifically United Healthcare) send when they intend to pay???
      > >
      > > Sandra
    • patricia_nielsen
      I have United Healthcare, and I have had my surgery denied twice, even though I have severe mandibular hypoplasia. My company s plan speficially excludes
      Message 2 of 7 , Aug 29, 2003
        I have United Healthcare, and I have had my surgery denied twice,
        even though I have severe mandibular hypoplasia. My company's plan
        speficially excludes orthognathic surgery, but I am trying to prove
        to my employer that this should be covered. Any suggestions?

        --- In orthognathicsurgerysupport@yahoogroups.com, kay88keys
        <no_reply@y...> wrote:
        > Steve, Tonia & Lisa - Thanks for writing. Guess I need to check
        > into things more. I didn't mention in the message below that
        > earlier I did get a denial letter & then also got a letter that it
        > went to appeals without my knowledge. Then I had trouble figuring
        > out how to contact the appeals because they faxed it to another
        > state, and nobody had the number. I got my HR person involved, who
        > made calls & told me that United Healthcare told them they were
        > going to pay for it. But I was concerned becauase the letter I
        > mentioned below seemed kind of unclear. I still have a fear that
        > it's in appeals without my knowledge.
        >
        > Sandra
        > --- In orthognathicsurgerysupport@yahoogroups.com, lmont_2000
        > <no_reply@y...> wrote:
        > > Sandra,
        > >
        > > I had United Healthcare when I had my surgery three years ago and
        > > they did send me a letter indicate what procedures they would
        > cover.
        > > The letter was fairly detailed and left no doubt in my mind about
        > > what they would cover. You should have your doctor's office
        pursue
        > > this and asked for a determination of benefits letter re: your
        > > surgery. Good luck and God Bless.
        > >
        > > Kindly,
        > > Lisa
        > >
        > >
        > >
        > > --- In orthognathicsurgerysupport@yahoogroups.com, kay88keys
        > > <no_reply@y...> wrote:
        > > > I'm trying to figure out if I really do have an approval letter
        > > from
        > > > United Healthcare or not (i.e. meaning they will pay for the
        > > > surgery)??? What does an approval letter normally say exactly?
        > > >
        > > > My doctor's office sent in the paperwork for a
        > predetermination.
        > > > The letter I got back says that "we were told about the
        > following
        > > > outpatient procedure" & lists the procedure codes & goes on to
        > say
        > > > the expected date is 6/5/03 (in reality, I am at least 4-6
        > months
        > > > away from surgery). It says to call after the procedure if a
        > > > hospital stay is required. Then it says "for eligibility or
        > > benefit
        > > > coverage, call the number on your card. Payment is based on
        > terms
        > > > of your benefit plan." At the top it has a "ref. num" which
        > they
        > > > told me on the phone was my authorization. I got the
        impression
        > > on
        > > > the phone that by getting this letter, it means they approve it
        > &
        > > > will pay for it. They said they can't issue this letter without
        > a
        > > > date, and the surgery has to be within 90 days of the letter
        for
        > > it
        > > > to be valid. My doctor's office said they sometimes give the
        > > > insurance a "dummy surgery date" just to try to get the
        > insurance
        > > > company to take action & issue a letter. I guess I was
        > expecting
        > > > the letter to be more specific about saying they would pay for
        > the
        > > > procedure. Is this normally what insurance companies (&
        > > > specifically United Healthcare) send when they intend to pay???
        > > >
        > > > Sandra
      • ebrown1003
        I just got approved by UHC and this surgery was also specifically excluded under my company s plan, but I found a way around it. Use the benefit handbook as
        Message 3 of 7 , Aug 30, 2003
          I just got approved by UHC and this surgery was also specifically
          excluded under my company's plan, but I found a way around it. Use
          the benefit handbook as your guide as you write your appeal letters -
          find out what they do cover and use that as your angle. Mine
          covered reconstructive surgery and that is what I used to get it
          covered!
          Emily
          --- In
          orthognathicsurgerysupport@yahoogroups.com, "patricia_nielsen"
          <patricia_nielsen@y...> wrote:
          > I have United Healthcare, and I have had my surgery denied twice,
          > even though I have severe mandibular hypoplasia. My company's
          plan
          > speficially excludes orthognathic surgery, but I am trying to
          prove
          > to my employer that this should be covered. Any suggestions?
          >
          > --- In orthognathicsurgerysupport@yahoogroups.com, kay88keys
          > <no_reply@y...> wrote:
          > > Steve, Tonia & Lisa - Thanks for writing. Guess I need to check
          > > into things more. I didn't mention in the message below that
          > > earlier I did get a denial letter & then also got a letter that
          it
          > > went to appeals without my knowledge. Then I had trouble
          figuring
          > > out how to contact the appeals because they faxed it to another
          > > state, and nobody had the number. I got my HR person involved,
          who
          > > made calls & told me that United Healthcare told them they were
          > > going to pay for it. But I was concerned becauase the letter I
          > > mentioned below seemed kind of unclear. I still have a fear that
          > > it's in appeals without my knowledge.
          > >
          > > Sandra
          > > --- In orthognathicsurgerysupport@yahoogroups.com, lmont_2000
          > > <no_reply@y...> wrote:
          > > > Sandra,
          > > >
          > > > I had United Healthcare when I had my surgery three years ago
          and
          > > > they did send me a letter indicate what procedures they would
          > > cover.
          > > > The letter was fairly detailed and left no doubt in my mind
          about
          > > > what they would cover. You should have your doctor's office
          > pursue
          > > > this and asked for a determination of benefits letter re: your
          > > > surgery. Good luck and God Bless.
          > > >
          > > > Kindly,
          > > > Lisa
          > > >
          > > >
          > > >
          > > > --- In orthognathicsurgerysupport@yahoogroups.com, kay88keys
          > > > <no_reply@y...> wrote:
          > > > > I'm trying to figure out if I really do have an approval
          letter
          > > > from
          > > > > United Healthcare or not (i.e. meaning they will pay for the
          > > > > surgery)??? What does an approval letter normally say
          exactly?
          > > > >
          > > > > My doctor's office sent in the paperwork for a
          > > predetermination.
          > > > > The letter I got back says that "we were told about the
          > > following
          > > > > outpatient procedure" & lists the procedure codes & goes on
          to
          > > say
          > > > > the expected date is 6/5/03 (in reality, I am at least 4-6
          > > months
          > > > > away from surgery). It says to call after the procedure if
          a
          > > > > hospital stay is required. Then it says "for eligibility or
          > > > benefit
          > > > > coverage, call the number on your card. Payment is based on
          > > terms
          > > > > of your benefit plan." At the top it has a "ref. num" which
          > > they
          > > > > told me on the phone was my authorization. I got the
          > impression
          > > > on
          > > > > the phone that by getting this letter, it means they approve
          it
          > > &
          > > > > will pay for it. They said they can't issue this letter
          without
          > > a
          > > > > date, and the surgery has to be within 90 days of the letter
          > for
          > > > it
          > > > > to be valid. My doctor's office said they sometimes give
          the
          > > > > insurance a "dummy surgery date" just to try to get the
          > > insurance
          > > > > company to take action & issue a letter. I guess I was
          > > expecting
          > > > > the letter to be more specific about saying they would pay
          for
          > > the
          > > > > procedure. Is this normally what insurance companies (&
          > > > > specifically United Healthcare) send when they intend to
          pay???
          > > > >
          > > > > Sandra
        • lepetite730
          United Healthcare covered my surgery (not braces though) 80% after I paid the $5000 annual deductible. So in essence, my surgery ended up costing $5000. The
          Message 4 of 7 , Sep 1, 2003
            United Healthcare covered my surgery (not braces though) 80% after I
            paid the $5000 annual deductible. So in essence, my surgery ended up
            costing $5000. The total though, with insurance footing the bill,
            was approximately $23,000. We have a PPO. I would not recommend
            trying to swing this surgery yourself, as it is extremely costly when
            you add in hospital stay (mine was four days due to fever and
            vomiting) and anethesia. My policy covers orthognathics due to
            accident or "birth malformation" as they so politely put it, but just
            because your doesn't cover it does not mean you shouldn't keep after
            them! Often times, they will make exceptions if you have enough
            medical documentation outlining how this adversely affects your life
            and the consequences if you don't have it done. DON'T GIVE UP!!!!
            Keep bugging them!

            bryant1003@p...> wrote:
            > I just got approved by UHC and this surgery was also specifically
            > excluded under my company's plan, but I found a way around it. Use
            > the benefit handbook as your guide as you write your appeal
            letters -
            > find out what they do cover and use that as your angle. Mine
            > covered reconstructive surgery and that is what I used to get it
            > covered!
            > Emily
            > --- In
            > orthognathicsurgerysupport@yahoogroups.com, "patricia_nielsen"
            > <patricia_nielsen@y...> wrote:
            > > I have United Healthcare, and I have had my surgery denied
            twice,
            > > even though I have severe mandibular hypoplasia. My company's
            > plan
            > > speficially excludes orthognathic surgery, but I am trying to
            > prove
            > > to my employer that this should be covered. Any suggestions?
            > >
            > > --- In orthognathicsurgerysupport@yahoogroups.com, kay88keys
            > > <no_reply@y...> wrote:
            > > > Steve, Tonia & Lisa - Thanks for writing. Guess I need to
            check
            > > > into things more. I didn't mention in the message below that
            > > > earlier I did get a denial letter & then also got a letter that
            > it
            > > > went to appeals without my knowledge. Then I had trouble
            > figuring
            > > > out how to contact the appeals because they faxed it to another
            > > > state, and nobody had the number. I got my HR person involved,
            > who
            > > > made calls & told me that United Healthcare told them they were
            > > > going to pay for it. But I was concerned becauase the letter I
            > > > mentioned below seemed kind of unclear. I still have a fear
            that
            > > > it's in appeals without my knowledge.
            > > >
            > > > Sandra
            > > > --- In orthognathicsurgerysupport@yahoogroups.com, lmont_2000
            > > > <no_reply@y...> wrote:
            > > > > Sandra,
            > > > >
            > > > > I had United Healthcare when I had my surgery three years ago
            > and
            > > > > they did send me a letter indicate what procedures they would
            > > > cover.
            > > > > The letter was fairly detailed and left no doubt in my mind
            > about
            > > > > what they would cover. You should have your doctor's office
            > > pursue
            > > > > this and asked for a determination of benefits letter re:
            your
            > > > > surgery. Good luck and God Bless.
            > > > >
            > > > > Kindly,
            > > > > Lisa
            > > > >
            > > > >
            > > > >
            > > > > --- In orthognathicsurgerysupport@yahoogroups.com, kay88keys
            > > > > <no_reply@y...> wrote:
            > > > > > I'm trying to figure out if I really do have an approval
            > letter
            > > > > from
            > > > > > United Healthcare or not (i.e. meaning they will pay for
            the
            > > > > > surgery)??? What does an approval letter normally say
            > exactly?
            > > > > >
            > > > > > My doctor's office sent in the paperwork for a
            > > > predetermination.
            > > > > > The letter I got back says that "we were told about the
            > > > following
            > > > > > outpatient procedure" & lists the procedure codes & goes on
            > to
            > > > say
            > > > > > the expected date is 6/5/03 (in reality, I am at least 4-6
            > > > months
            > > > > > away from surgery). It says to call after the procedure if
            > a
            > > > > > hospital stay is required. Then it says "for eligibility
            or
            > > > > benefit
            > > > > > coverage, call the number on your card. Payment is based
            on
            > > > terms
            > > > > > of your benefit plan." At the top it has a "ref. num"
            which
            > > > they
            > > > > > told me on the phone was my authorization. I got the
            > > impression
            > > > > on
            > > > > > the phone that by getting this letter, it means they
            approve
            > it
            > > > &
            > > > > > will pay for it. They said they can't issue this letter
            > without
            > > > a
            > > > > > date, and the surgery has to be within 90 days of the
            letter
            > > for
            > > > > it
            > > > > > to be valid. My doctor's office said they sometimes give
            > the
            > > > > > insurance a "dummy surgery date" just to try to get the
            > > > insurance
            > > > > > company to take action & issue a letter. I guess I was
            > > > expecting
            > > > > > the letter to be more specific about saying they would pay
            > for
            > > > the
            > > > > > procedure. Is this normally what insurance companies (&
            > > > > > specifically United Healthcare) send when they intend to
            > pay???
            > > > > >
            > > > > > Sandra
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