Fought UHC and WON!

[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.

[Shay]

That is so awesome!
All that wait and work! Anytime one of us wins we all do!

[prusinski]

gymnast1981

Any chance I can contact you? Email preferred.

I'm from Wisconsin also using UHC with ProdiscLTDR recommendation and initial denial last year. Been trying to use IL-WC and UHC as private carrier.

I'm very pleased to hear you have finally been approved for the treatment your doctor ordered. I'd be a little nervous too, because any of these surgeries are incredible undertakings. You've lived through the toughest fight though; insurance hell!

I have some questions I'd love to ask you about who you finally selected for the surgery, the hospital, etc. I've been at this about two years and it sounds like you have some good advice with local experience. Thanks for paving the way with UHC

Bob (at ) gbnpro.com

[gymnast1981]

ill be emailing you shortly

[stinaBan93]

Hello,

Congratulations on beating UHC for your Lumbar ADR surgery. We are fighting the same battle with UHC over claim denial.

I'm 18 years old and have needed ADR for over a year. I had microdiscectomy surgery summer of 2011 after UHC denied ADR surgery at that time (and denied all our appeals). The disc started bulging again by October 2011 and was fully herniated by March 2012.

I am scheduled for ADR surgery this Friday, May 25, and my family has pulled money out of college savings to pay for it. UHC has again denied coverage this year, and denied the peer-to-peer review.

We have contacted several media outlets and customer advocates, a lawyer's office specializing in insurance bad faith cases, the Synthes ProDisc PAL. We will be picketing the UHC office in Cypress, CA this Wednesday May 23 from 11 AM to 1 PM.

At this point we want UHC to not only cover my procedure, but also change their policy so others can have Lumbar ADR without having to go through this nightmare.

I've set up a facebook page - search 'BackMyBack' with my story.

I would love to talk or email you directly to find out more about your story, your recovery experience after surgery, and find out how you are doing 6 months after surgery.

Thanks

http://www.facebook.com/BackMyBack

[gymnast1981]

it took me over 8 months of fighting UHC and we finally beat them because we asked for an EXTERNAL REVIEW because their "expert" was a peditration that graduated med school in 1960. i mean come on!!! and the whole process was a hurry up and wait.

im 6 months as of tomorrow!!!!! and i am doing AMAZING. i have ALL of my flexibility i had before surgery. wait let me restate that... i have MORE flexibility then i had before surgery. i would say that my pain has gone down a good 75% and gets better every day.

ill message you and you can email me (its easier to contact me via email since at work this site is blocked) but i can get email
who are you working with at PAL? they are the ones that got my denial overturned and they will work very hard on your case