[gymnast1981]

I have posted already, but one more time to let everyone know that you can fight the big bad insurance company and WIN

For those of you that may not know. I have been fighting UHC for over 6 months to approve ADR for L4-L5 and was denied twice.

For a few weeks in the beginning UHC kept dragging their feet. After my claim was denied it took UHC forever to get a letter generated and sent out. They kept saying that the letter was sent or a day later they would say that because no one asked for the letter was never generated... and yet we have been in contact with UHC many times to get this letter so we could start the appeal.


After we finally got the denial letter, the appeal process finally began. My doctor set me up with P.A.L (ProDisc Patient Assistance Line) and they took care of everything. They wrote up the appeal and all I had to do was wait. So the first request was denied, and we were very ready for that decision. The next step was to appeal. A conference call took place to plead my case to UHC. It wasn't even a full day before they sent a letter stating that they were going to uphold the decision for denial. They didn't listen to me or Lindstrom (my advocate) as to why I needed ADR.

So now we entered the 2nd and final appeal. This time an IRO (independent review origination) took the claim and the wait began. This time it took about 30 business days to reach a decision.

The decision turned out to be life changing!!!

November 2, 2011 was one of the best days I have had in a LONG time. I had a short day at work and once I got home I got a call from my HR department offering me a promotion!!! Then a few hours later the mail came and in it was a letter from UHC. My heart started to race I was so nervous! I opened it up and it stated...

"An independent review company, MCMC LLC, reviewed the request to reconsider our previous decision regarding the service you requested. We're pleased to tell you that your request is approved"

After I realized what it said I ran upstairs to where my husband was trying to sleep... oops! I scared the ... out of him. I yelled his name and was almost screaming "my surgery is approved!!!!!" he jolted up and was like "what! what! happen!" I think he thought I fell down the stairs or something.

And now the journey begins...

My surgery for ADR is now scheduled for November 29, 2011. It has been a long 7 years waiting to get my back fixed.

So for anyone that has UHC or any other insurance; there is hope out there! If it weren't for P.A.L and Walter Lindstrom I don't think i would have been approved. If I didn't have these resources helping me appeal I would have never known that an IRO can be called in to appeal the insurance company.

I am extremely happy and excited yet nervous about ADR. But anything would be better then the chronic pain I have been living in for the past 7 years.