I am awaiting the results from first appeal and frustrated with the treatment I've received from UnitedHealthcare. For over four months they had trouble receiving faxes from dr's office. Then my denial letter said I would know in less than 15 calendar days. They couldn't figure out how I got that idea until I faxed them a copy of their own denial. They said it should be 30 days...and now they haven't met that deadline, July 6th.
I've contacted some congressmen. But I think we can learn from each other and maybe get the approval we all want.
Feel free to email me at konnie_petteway@yahoo.com

I also had ALOT of trouble with UHC receiving faxes from the doctors office too! I just basically kept calling and bugging them to death. My appeal for ADR got denied because, again, they feel it is experimental. They didn't respond in the 15 days they said they would - it was closer to 30 days. I wrote all my local representatives and US Congressman/Senators when I sent my appeal. I got two responses - one was a politically "canned" response. The other was from a State Representative who said they would put in a word with UHC and the state insurance. Unfortunately, it didn't help.
I believe there is something in the way the FDA wrote the approval that there is some sort of loophole that allows the insurance to label it "experimental".

Hugs,
Kat

Kristi:
I too have United (PPO) but I am just beginning to contact neurosurgeons so I haven't had to deal with United yet (although they keep sending letters asking if I've applied for disability yet so they don't have to pay their pittance for physical therapy). But please do post your experiences and progress--and I will certainly let you know if/when I get to that point.

I can't speak to UHC, but I can tell you that the legal document that contains the description of services by Blue Cross stipulates that they respond within a certain number of days to each request and appeal. I strongly recommend you review the actual contract you have with UHC to determine if there are clauses about timing of responses from them (and yourself, for that matter). I can't say this with any certainty, but I wouldn't be surprised to find out that these sorts of things are in your state laws (or should be!).

If you meet all the contractual requirements and they don't meet theirs then you may very well have cause for legal action, threat of which is many times all it takes to get non-payers off their duffs. I'd also suggest that you might copy the appropriate pages of your contract (with specific clauses highlighted) and send them along with pertinent appeal papers by registered mail rather than faxing, to show them you now understand exactly what they are required to do and intend to seek legal remedy if they do not.

I have a pretty strong suspicion, based on these two identical cases of missed-fax-excuses, that they are pulling delay tactics on you to get you to give up prematurely. Don't give up!

Kristi.

I had loads of fun with UHC prior to my fusion surgery.

If you read the FINE print any letter they send says they will respond in 15 days, but later in the letter it states they can extend that as long as they wish if they need to study the case further, which is garbage. I could have had my fusion surgery months ago if I wasnt waiting on their replies....

If you are at the point where you are on the last appeal to their SLC center I would say to call them and bug them daily. Thats what it took for me top get my final denial in a months timeframe...

John

John,

There was no fine print. They acknowledged that it said 15 days after I faxed them the denial letter. I've talked to people in Consumer Affairs Dept and the National Appeals Center, but I'm not sure what SLC is.

Kristi

Kristi,

Sorry, SLC is their Salt Lake City Appeals Center, I bugged them twice a week before getting my final denial letter from them....

John

Same here. Lost faxes, etc. I decided not to even bother with an appeal as I know where that will go.