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The Big File All issues not easily categorized in the above forums are here. Comments on general health, diet, "getting comfortable," and more are here.


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  #1  
Old 07-09-2005, 12:54 PM
kristi kristi is offline
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I am awaiting the results from first appeal and frustrated with the treatment I've received from UnitedHealthcare. For over four months they had trouble receiving faxes from dr's office. Then my denial letter said I would know in less than 15 calendar days. They couldn't figure out how I got that idea until I faxed them a copy of their own denial. They said it should be 30 days...and now they haven't met that deadline, July 6th.
I've contacted some congressmen. But I think we can learn from each other and maybe get the approval we all want.
Feel free to email me at konnie_petteway@yahoo.com
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DDD for 15 years.
ADR candidate L4-L5, L5-S1
UHC insurance
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  #2  
Old 07-09-2005, 04:23 PM
Kat Kat is offline
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Join Date: Jun 2005
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I also had ALOT of trouble with UHC receiving faxes from the doctors office too! I just basically kept calling and bugging them to death. My appeal for ADR got denied because, again, they feel it is experimental. They didn't respond in the 15 days they said they would - it was closer to 30 days. I wrote all my local representatives and US Congressman/Senators when I sent my appeal. I got two responses - one was a politically "canned" response. The other was from a State Representative who said they would put in a word with UHC and the state insurance. Unfortunately, it didn't help.
I believe there is something in the way the FDA wrote the approval that there is some sort of loophole that allows the insurance to label it "experimental".

Hugs,
Kat
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1/91 Fell L4/5 L5/S1 herniation
11/92 disketomy-No pain!
3/03 Pain L4/5 L5/S1 DDD
5/04 TBI/Dr Zigler recommends 1 level ADR
4/05 UHC denies Charite. Appealed-Denied again
6/05 Scheduled fusion 6/28
6/05 Fusion cnxl'd-
6/05 Fusion w/NS 7/26 at 7:30am
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  #3  
Old 07-09-2005, 04:27 PM
sahuaro sahuaro is offline
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Join Date: May 2005
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Kristi:
I too have United (PPO) but I am just beginning to contact neurosurgeons so I haven't had to deal with United yet (although they keep sending letters asking if I've applied for disability yet so they don't have to pay their pittance for physical therapy). But please do post your experiences and progress--and I will certainly let you know if/when I get to that point.
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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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  #4  
Old 07-10-2005, 03:11 PM
Rein Rein is offline
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Join Date: Apr 2005
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I can't speak to UHC, but I can tell you that the legal document that contains the description of services by Blue Cross stipulates that they respond within a certain number of days to each request and appeal. I strongly recommend you review the actual contract you have with UHC to determine if there are clauses about timing of responses from them (and yourself, for that matter). I can't say this with any certainty, but I wouldn't be surprised to find out that these sorts of things are in your state laws (or should be!).

If you meet all the contractual requirements and they don't meet theirs then you may very well have cause for legal action, threat of which is many times all it takes to get non-payers off their duffs. I'd also suggest that you might copy the appropriate pages of your contract (with specific clauses highlighted) and send them along with pertinent appeal papers by registered mail rather than faxing, to show them you now understand exactly what they are required to do and intend to seek legal remedy if they do not.

I have a pretty strong suspicion, based on these two identical cases of missed-fax-excuses, that they are pulling delay tactics on you to get you to give up prematurely. Don't give up!
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03/09/26 - Ruptured L5-S1.

Years of pain, discectomy, research into anatomy, hardware, clinical trials, facilities, surgeons, techniques, insurance. Attempts at ProDisc, Activ-L trials. Now, low bone density. D'oh!!!

At 61 years, no longer qualifying for trials due to my age (chronological, not physical or mental).

2009 - Working on improving bone density or getting rich so I can go to Germany, where medicine and insurance have gone beyond the Stone Age.
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  #5  
Old 07-12-2005, 05:34 PM
NCFUSED NCFUSED is offline
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Kristi.

I had loads of fun with UHC prior to my fusion surgery.

If you read the FINE print any letter they send says they will respond in 15 days, but later in the letter it states they can extend that as long as they wish if they need to study the case further, which is garbage. I could have had my fusion surgery months ago if I wasnt waiting on their replies....

If you are at the point where you are on the last appeal to their SLC center I would say to call them and bug them daily. Thats what it took for me top get my final denial in a months timeframe...

John
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John
Greensboro, NC
DDD L5-S1
Lost all ADR Appeals w/ UHC PLIF Fusion L5-S1 on 5/17/05.
Pars Defect L3-L4
DDD L3-L4 L4-L5
3 LVL Fusion Scheduled 4/08
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  #6  
Old 07-21-2005, 10:50 AM
kristi kristi is offline
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John,

There was no fine print. They acknowledged that it said 15 days after I faxed them the denial letter. I've talked to people in Consumer Affairs Dept and the National Appeals Center, but I'm not sure what SLC is.

Kristi
__________________
DDD for 15 years.
ADR candidate L4-L5, L5-S1
UHC insurance
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  #7  
Old 07-21-2005, 11:07 PM
NCFUSED NCFUSED is offline
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Posts: 128
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Kristi,

Sorry, SLC is their Salt Lake City Appeals Center, I bugged them twice a week before getting my final denial letter from them....

John
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John
Greensboro, NC
DDD L5-S1
Lost all ADR Appeals w/ UHC PLIF Fusion L5-S1 on 5/17/05.
Pars Defect L3-L4
DDD L3-L4 L4-L5
3 LVL Fusion Scheduled 4/08
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  #8  
Old 07-22-2005, 03:07 PM
Paul Paul is offline
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Join Date: Oct 2004
Posts: 57
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Same here. Lost faxes, etc. I decided not to even bother with an appeal as I know where that will go.
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