Anyone approved by UHC?
 

I am starting to gather up my info for my first appeal. My HR departmnet says UHC wants to see "which carriers have covered this procedure and for whom" I thought I would start off by seeking out folks who have been approved by UHC. Please PM or email me if you have been successful with UHC.

Thanks,

Paul

Paul--
I too have United but have not yet gotten to the point of asking for approval. However, I think your HR department request is very strange and very out line, violating HIPAA privacy rules--are you supposed to supply them with patient names????

I think as long as you have the patient's permission it's ok. I agree that it's a strange request but it's not exactly HIPAA since you're not asking another insurance company to divulge names but rather the person. I had the same thought at first though.

Andrea

I know you want to provide them with the information they are asking for but shouldn't the HR Dept. be doing this research rather than the patient? They probably have easier access to the data. I'd also be concerned about HIPAA even if a patient here wants to provide the information to your HR Dept. Maybe they are wanting numbers of patients (no names), the carriers, and what levels were done?

Paul you can go to the website for Aetna and get their policy on ADR. They approve at least one level. I have asked others to give me their approval letter with all identifying info blacked out so I can use this with my appeal letter to show our insurance company that others are approving this procedure. It does not violate HIPPA if you yourself provide the info and there is no identifying information on the letter. Also HIPPA only applies to healthcare providers and insurance companies etc. It does not apply to the private citizen.
I think it stinks that we have to get all this stuff ourselves but if we want it done we have to do it.

I stand corrected. As a provider, I have a knee-jerk reaction to any infringement on patient privacy. Even so, the thought of providing actual names does not feel right. I would support Kim's suggestion of deleting any identifying info--this is what providers would do and this is all insurance companies have a right to receive.

It was UHC that was requesting it not HR. From me starting to dig into this I get the imnpression that UHC thinks the these artificial disks just fell out of the sky within the past year and they are all standing around it looking at it saying ohhhh what is that shiny thing? They seem totally clueless. Part of what I left out to the original post in addition to the which and who was; "was the coverage issue imapcted by the severity of the diagnosis or previous treatment tried without success" I don't even think they read the FDA approval which requires 6 months of conservative treatment, etc.


Kim, I plan on using the aetna policy as part of my appeal.

If anyone wants to keep their name out of it that's fine with me.

Paul:
I still think UHC is out of line in asking you to do all this research for them--but it was this kind of intrusive behavior that led me to resign from their panel as a provider.
Nevertheless, since I may be following you in requesting coverage, I appreciate that you are paving the path for me. Please let me know if I can help in any way.
Barbara

Hi
Has anyone gotten anywhere positive with UHC yet and have anything to share?
I just got my denial letter. The language they used was "unproven" (as opposed to experimental or investigational I was expecting) and "not a covered benefit."
Sound familiar to other UHC people? Anyone else's employer on UHC self-insured plan? Does self-insured matter?
So here I go with my appeal...fingers and toes crossed.
Thanks.

I went the distance with United for a 2 level adr.
Ultimately, I was denied.I will be going to Munich in a few weeks on my own dollar. The funny thing is, I'm more positive about the outcome now. The doctor we're going to in Germany has more experience than anyone else in the world. Here, their experience is minimal.