[gymnast1981]

so I've been looking into the reason why they denied my claim after an IRO overturned the claim and approved it, UHC PAID for Anesthesia, Hospital stay, Radiology but they won't pay for the surgeons... um what the heck!

on my online benefit explanations of claims paid the two things that are not paid are both surgeons so to me I could have the procedure but I couldn't have the two people who know what they are doing put it in? does this sound strange to anyone else?

here is what they state for why they are denying to pay the surgeons...
we went through this and it was approved so I'm really confused.

ANYONE ELSE HAVE THIS ISSUE?




*Remark Code PE: Based On The Information Provided, This Service Is Unproven And Is Not Covered. Therefore, No Benefits Are Payable For This Expense. In Order For This Service To Be Considered For Coverage, Scientific Evidence Must Be Submitted, That Meets The Standards Described In Your Benefit Plan Language, That Demonstrates The Safety And Effectiveness Of This Service For Your Particular Condition. If The Service Was Received From A Participating Provider, The Provider May Not Balance Bill For The Service Unless The Member Has Given Pre-service Written Consent To The Ordering Or Rendering Provider To Be Billed.