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Insurance Hell All insurance-related matters are here: Medicare, worker's compensation, appeals, denials, insights, wins, losses. PRICING is here too. Note: This forum has posts from 2006 forward. Older ones are in the Big File.


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  #1  
Old 08-29-2005, 05:23 PM
Paul Paul is offline
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Default 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
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  #2  
Old 08-29-2005, 07:43 PM
sahuaro sahuaro is offline
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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????
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2001 MVA; C5-C6 disk extruded
ongoing physical therapy, exercise and massage
ESI's, oral prednisone, trigger point injections
foraminal and central stenosis C5/C6 and c6/C7
2007 EMG/nerve conduction shows pattern of chronic radiculopathy
January, 2008: Prestige ST Artificial Disk Replacement, C5/6
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  #3  
Old 08-29-2005, 08:05 PM
APS APS is offline
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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
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Andrea
Grand Junction/Denver, CO

Failed L4-5 diskectomies '93 & '00
ADR originally scheduled 3/9/05; dropped insurance appeal due to new job; new insurance UHC
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  #4  
Old 08-29-2005, 08:40 PM
spotty14 spotty14 is offline
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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?
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7/05 EMG/Nerve Conduction Tests
8/04 Disqualified from ADR clinical trial due to severe osteoporosis -- getting treatment
3/04 updated MRI
11/2000 IDET L 3/4, L4/5
1/2000 Discogram
numerous epidural injections
physical therapy
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  #5  
Old 08-30-2005, 12:15 AM
Kim Kim is offline
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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.
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Kim
Herniated disc L5/S1 2000 Discectomy 10/2003 Rhizotomy 8/2004 and 3/2005Discogram 11/04 grade 7 tear L5/S1
L4/L5 Grade 5 tear with herniation and stenosis
Evaluated by Dr Blumenthal at TBI
2/2005 ADR 2 level recommended
2 level lumbar fusion
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  #6  
Old 08-30-2005, 01:50 AM
sahuaro sahuaro is offline
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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.
__________________
2001 MVA; C5-C6 disk extruded
ongoing physical therapy, exercise and massage
ESI's, oral prednisone, trigger point injections
foraminal and central stenosis C5/C6 and c6/C7
2007 EMG/nerve conduction shows pattern of chronic radiculopathy
January, 2008: Prestige ST Artificial Disk Replacement, C5/6
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  #7  
Old 08-30-2005, 10:06 AM
Paul Paul is offline
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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.
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  #8  
Old 08-30-2005, 03:43 PM
sahuaro sahuaro is offline
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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
__________________
2001 MVA; C5-C6 disk extruded
ongoing physical therapy, exercise and massage
ESI's, oral prednisone, trigger point injections
foraminal and central stenosis C5/C6 and c6/C7
2007 EMG/nerve conduction shows pattern of chronic radiculopathy
January, 2008: Prestige ST Artificial Disk Replacement, C5/6
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  #9  
Old 12-28-2005, 04:45 PM
APS APS is offline
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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.
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Andrea
Grand Junction/Denver, CO

Failed L4-5 diskectomies '93 & '00
ADR originally scheduled 3/9/05; dropped insurance appeal due to new job; new insurance UHC
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  #10  
Old 12-28-2005, 06:09 PM
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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.
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