Re: Insurance issues--United Healthcare and Unicare

[Guest guest]

Kerri -

UHC has denied us (and another member here in Ohio) 3 times.

We are onto the Ohio Dept of Insurance. We have an orthotics

exclusion.

I was told 5 or 6 times verbally by Customer Service that I was

cover 80/20 with a $500 copay.

Keep names of everyone with whom you speak.

They are very inconsistent. They are out of complaince with IRISA

laws. They need to have continuity and they don't - at all.

Good luck!

Dane's mom DOC Grad

> Hi everybody,

>

> We're just finding out we will likely need to seek treatment for

our

> daughter, . I of course have many financial concerns.

>

> I am covered under United Healthcare right now. They have told me

verbally

> over the phone (would NOT supply any written documentation) that

they will

> cover 70% only if her diagnosis is considered " severe. "

>

> I saw in the site files that some of you have had success with

United

> Healthcare (100%) and some of you have had no success with them at

all (0%).

> How is it that some people have been covered 100%, I've been told

70% if

> severe, and some haven't been covered at all?

>

> Is this dependent on the state in which we live? Can we use this

in an

> appeal? (i.e., " we know United Healthcare covered Jane Doe in AZ

for 100%...)

>

> I am changing over to Unicare in August, so I am also wondering

about

> anyone's success with this company. Any luck?

>

> Thanks,

> Kerri (mommy of 6-month old )

> Chicago, IL

[Guest guest]

Kerri,

United Healthcare seems to be denying everyone these days except for

those in Florida and Georgia. I am fighting UHC in Ohio with

. We have this vague language in the exclusion section of our

certificate of coverage that says " orthotic applainces including shoe

inserts " are excluded " . This is what UHC is referring to when they

tell us we are not covered because we have an orthotics excusion.

However, this is just complete bull crap because another person here

in Cleveland also got denied and he does NOT have this language.

They just used some other reason for him. I think they used

" cosmetic " for him. Its all just one big name game! Also, its

covered under DME and not Orthotics anyways!

Appeal Appeal Appeal, and use any info you can. Not to discourage

you, but I gathered a list of fourteen people across the country

where UHC ended up paying (100%, 80% all different amounts and

reasons). I included it in my appeal, and we still lost! Some people

gave me permision to use the last name, others I blanked it out for

confidentiality. UHC does not need us to provide them with

names..they know very well who they have covered. IT is in their

claims databases. I have this list if you want it. I can be reached

at leslie_O'Donnell@... or userlko@...

Since you live in Chicago, I think that is good for you. You should

contact that attourney general that is suing BCBS in Chicago. Do you

have that article? I think it is in the database on this site.

Good luck,

> Hi everybody,

>

> We're just finding out we will likely need to seek treatment for

our

> daughter, . I of course have many financial concerns.

>

> I am covered under United Healthcare right now. They have told me

verbally

> over the phone (would NOT supply any written documentation) that

they will

> cover 70% only if her diagnosis is considered " severe. "

>

> I saw in the site files that some of you have had success with

United

> Healthcare (100%) and some of you have had no success with them at

all (0%).

> How is it that some people have been covered 100%, I've been told

70% if

> severe, and some haven't been covered at all?

>

> Is this dependent on the state in which we live? Can we use this in

an

> appeal? (i.e., " we know United Healthcare covered Jane Doe in AZ

for 100%...)

>

> I am changing over to Unicare in August, so I am also wondering

about

> anyone's success with this company. Any luck?

>

> Thanks,

> Kerri (mommy of 6-month old )

> Chicago, IL

[Guest guest]

United healthcare paid for our helmet out of network 100% under

DME and it was $3500. I read that UHC paid for it because the Plagio

was caused with Mackenzie in utero. They change the rules daily and

its decided by a case by case and they never publish the " rules " . The

easiest way to get paid is use a physician that is familiar with

providing the Ins with the right documentation and measurements or

take it on yourself and fight.

UHC tried to pay out of network for us 70% at first but when I

asked who was in network they hadent anyone so they pais 100%.

Lorraine.

> Hi everybody,

>

> We're just finding out we will likely need to seek treatment for

our

> daughter, . I of course have many financial concerns.

>

> I am covered under United Healthcare right now. They have told me

verbally

> over the phone (would NOT supply any written documentation) that

they will

> cover 70% only if her diagnosis is considered " severe. "

>

> I saw in the site files that some of you have had success with

United

> Healthcare (100%) and some of you have had no success with them at

all (0%).

> How is it that some people have been covered 100%, I've been told

70% if

> severe, and some haven't been covered at all?

>

> Is this dependent on the state in which we live? Can we use this in

an

> appeal? (i.e., " we know United Healthcare covered Jane Doe in AZ

for 100%...)

>

> I am changing over to Unicare in August, so I am also wondering

about

> anyone's success with this company. Any luck?

>

> Thanks,

> Kerri (mommy of 6-month old )

> Chicago, IL