Insurance issues--United Healthcare and Unicare

[Guest guest]

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]

Hi Kerry and welcome!

I certainly understand your concerns. Fighting the insurance companies is,

unfortunately, something many of us here have had WAY too much experience

with. Yes, the insurance coverage will vary from state to state and dependent

on your state's mandates. In Oklahoma insurance policies cannot exclude

orthotics and DME (durable medical equipment) so we had coverage for that

through WellCor, but it was clear that they do not cover that in states where

they don't have to. Check your policy and see if they cover DME - that should

be what the band is covered under. Our policy only covers DME up to 70% when

medically necessary - so we knew from the start that part of the expense

would be ours.

If you can get a letter of medical necessity from your specialist it will

help your case. If your ped is supportive you might get him/her to write one

as well. Also, keep a very thorough and detailed log of ALL phone calls (who,

what time, date and summary) and a copy of every document that is even sort

of related to the diagnosis and treatment of the plagio.

Best wishes and please keep us posted. I hope that UHC will cover their

portion from the start without having to fight. However, if they deny

remember that you can (and should) appeal the decision.

Marci (Mom to )

Oklahoma