Well, just heard from UHC today, My appeal was denied. Now its back to Microsoft Word, I found out my company is self insured and has a benefits appeal committee, so its time to type a letter to them and also to the NC State Insurance Board since they only give me 60 days to appeal to them. Hopefully one of the two will give me a thumbs up...... Everytime I see an insurance Commercial (both UHC and BCBS have them on throughout the day now) I want to vomit!!!

http://adrsupport.org/groupee_common...icon_frown.gif

Not that this may help a lot, but I am presuming that you have already seen this link concerning Aetna:

http://adrsupport.org/private-cgi-bin/ultimatebb.cgi?ub...t_topic;f=3;t=000187

I am hoping that I have better luck with UHC in May when I have my apppointment with the neurosurgeon....

David

John

I went thru an appeals process to my company's benefits commitee and was successful....the reason that you had issues with your "insurance provider" (basicall the 3rd party administrator for your company plan) was they keep the gate for your company plan. If the company says let someone thru, they will without a thought, but they are not allowed to let someone thru outside of the plan rules established without the ok from the company benefits committee....ever. Present to your company.....now you can use an economic argument because to them, it will be about money. If you have been with your firm a long time (thus suggesting you probably will be there long into the future) this helps you case (because if you are there another 10 years, you back problem is their economic problem).......email me if you want to talk offline.

Regarding the mention of the Aetna link, remember self insured plans are very different that fully insured plans.....appeals need to be handled very very differently depending on which bucket you are in......the Aetna stuff regards fully insured plans so would not apply complete to you John.

Thanks ESL,
Just typed up my letter to my Company Benefits Commitee, hopefully I will have the same luck as you. If not, then its another letter to the State Bureau of Insurance.

How long did it take for your company to make a decision???

Best wishes with your April 28th Surgery!!!

Thanks!

John

It took 1 year but its because our benefits manager from early in the process did not understand all this stuff (ie, the appeals process for a self-retention plan). after i was denied the first time and 6 months passed, she left and we got a new benefits manager (highly competent and one of the best in the business)......I told her my situation and she set up a proper benefits committee. After that committee reviewed my package I had my approval in a month.

My Goodness....
I sure hope it doesnt take me that long. I work for a Large Bank. so hopefully they have been through this before. They already have a Benefits Claims Committee in place, so hopefully they have their act together..... I really dont want to wait another year.....

Thank You so Much for the information!