Re: United Healthcare denies claim for PT

[Guest guest]

Becky,

I am so sorry to hear this! Our experience with UHC has been awful, as well,

and I've come

to bellieve that the only way for a just outcome with this company is to take

them to court.

I'm working on it.

>

> Two issues with these people.

>

> #1 - They won't pay for the last 2 months of physical therapy for my

> son's tort. Only one of the " approved " PT rehab centers within 40-50

> miles of me does pediatric rehab and admitted having no PT's with much

> experience treating babies with tort. My doctor referred me to a

> children's hospital only 10 miles from my house who specialize in

> pediatrics and have extensive experience treating kids with tort and

> are banded. The children's hospital took my insurance info 2 weeks

> before our first appt and " verified " benefits. When they did this,

> UHC told them how many visits I was approved for and what my co-pay

> was, but never mentioned or indicated to the person calling that the

> facility was " out of network " . I'm sure the person calling had to

> identify themself and where they were calling from. Very

> irresponsible on UHC's part. I assumed everything was in place and

> approved since they had been in contact with each other over benefit

> information. Big mistake on my part. After 2 months of weekly

> therapy, UHC finally contacted me with a denial of coverage because I

> didn't receive prior approval before receiving treatment. Now we owe

> $1800 for 2 months of PT. We've also had to quit therapy because we

> can't afford to pay out of pocket. We received a letter of medical

> necessity from our doc today and plan to appeal charges for the last

> two months as well as getting future visits approved. In the

> meantime, my son has been without therapy for a month and probably

> won't be returning unless UHC decides to approve future visits. So

> frustrating. I don't see why I should have to go to a facility who

> has such limited experience dealing with this problem when I can go to

> one that has so much experience. There is no comparison in the

> quality of care that can be provided to my son by going to the

> children's hospital. The letter my doc wrote stated just that. The

> " out of network " hospital has also agreed to accept whatever payment

> UHC would normally pay an " in network " provider so I can't imagine why

> they would deny coverage for future visits. Let's not forget we're

> dealing with UHC, not exactly known for being fair-minded or rational.

> Who knows what they will decide.

>

> #2

> Our policy has an " orthotics exclusion " as well, but the agent

> mentioned nothing specifically about " cranial remolding " helmets being

> excluded. I gave UHC the helmet code my PT gave me so they could look

> up coverage benefits specific to that. The UHC agent told me that it

> came up as being a claim that would have to be manually pre-approved

> by a committee that could take 2-3 weeks. Since I was fairly certain

> they were going to deny coverage anyway, I went ahead and banded my

> son. I didn't want to waste precious time waiting for their denial

> while my son was steady getting older. Haven't gotten the denial

> letter for the helmet yet. I'm sure it's on the way.

>

>

> Has anyone had success with UHC on any level? Any tips for dealing

> with these people or how to successfully appeal a previously denied

> claim? Any info in greatly appreciated.

>

> Becky

> mom to Will (STARband 4-3-06)

>

[Guest guest]

-

Keep us updated if you make any progress!

> >

> > Two issues with these people.

> >

> > #1 - They won't pay for the last 2 months of physical therapy

for my

> > son's tort. Only one of the " approved " PT rehab centers within

40-50

> > miles of me does pediatric rehab and admitted having no PT's

with much

> > experience treating babies with tort. My doctor referred me to a

> > children's hospital only 10 miles from my house who specialize in

> > pediatrics and have extensive experience treating kids with tort

and

> > are banded. The children's hospital took my insurance info 2

weeks

> > before our first appt and " verified " benefits. When they did

this,

> > UHC told them how many visits I was approved for and what my co-

pay

> > was, but never mentioned or indicated to the person calling that

the

> > facility was " out of network " . I'm sure the person calling had

to

> > identify themself and where they were calling from. Very

> > irresponsible on UHC's part. I assumed everything was in place

and

> > approved since they had been in contact with each other over

benefit

> > information. Big mistake on my part. After 2 months of weekly

> > therapy, UHC finally contacted me with a denial of coverage

because I

> > didn't receive prior approval before receiving treatment. Now

we owe

> > $1800 for 2 months of PT. We've also had to quit therapy

because we

> > can't afford to pay out of pocket. We received a letter of

medical

> > necessity from our doc today and plan to appeal charges for the

last

> > two months as well as getting future visits approved. In the

> > meantime, my son has been without therapy for a month and

probably

> > won't be returning unless UHC decides to approve future visits.

So

> > frustrating. I don't see why I should have to go to a facility

who

> > has such limited experience dealing with this problem when I can

go to

> > one that has so much experience. There is no comparison in the

> > quality of care that can be provided to my son by going to the

> > children's hospital. The letter my doc wrote stated just that.

The

> > " out of network " hospital has also agreed to accept whatever

payment

> > UHC would normally pay an " in network " provider so I can't

imagine why

> > they would deny coverage for future visits. Let's not forget

we're

> > dealing with UHC, not exactly known for being fair-minded or

rational.

> > Who knows what they will decide.

> >

> > #2

> > Our policy has an " orthotics exclusion " as well, but the agent

> > mentioned nothing specifically about " cranial remolding " helmets

being

> > excluded. I gave UHC the helmet code my PT gave me so they

could look

> > up coverage benefits specific to that. The UHC agent told me

that it

> > came up as being a claim that would have to be manually pre-

approved

> > by a committee that could take 2-3 weeks. Since I was fairly

certain

> > they were going to deny coverage anyway, I went ahead and banded

my

> > son. I didn't want to waste precious time waiting for their

denial

> > while my son was steady getting older. Haven't gotten the denial

> > letter for the helmet yet. I'm sure it's on the way.

> >

> >

> > Has anyone had success with UHC on any level? Any tips for

dealing

> > with these people or how to successfully appeal a previously

denied

> > claim? Any info in greatly appreciated.

> >

> > Becky

> > mom to Will (STARband 4-3-06)

> >

>

[Guest guest]

I am so sorry to hear that he can't continue treatment. That is

just awful. You must be so frustrated. I wish I had some advice

for you. Sorry.

Haylee

mom to andre doc band grad

>

> Two issues with these people.

>

> #1 - They won't pay for the last 2 months of physical therapy for

my

> son's tort. Only one of the " approved " PT rehab centers within 40-

50

> miles of me does pediatric rehab and admitted having no PT's with

much

> experience treating babies with tort. My doctor referred me to a

> children's hospital only 10 miles from my house who specialize in

> pediatrics and have extensive experience treating kids with tort

and

> are banded. The children's hospital took my insurance info 2 weeks

> before our first appt and " verified " benefits. When they did this,

> UHC told them how many visits I was approved for and what my co-pay

> was, but never mentioned or indicated to the person calling that

the

> facility was " out of network " . I'm sure the person calling had to

> identify themself and where they were calling from. Very

> irresponsible on UHC's part. I assumed everything was in place and

> approved since they had been in contact with each other over

benefit

> information. Big mistake on my part. After 2 months of weekly

> therapy, UHC finally contacted me with a denial of coverage

because I

> didn't receive prior approval before receiving treatment. Now we

owe

> $1800 for 2 months of PT. We've also had to quit therapy because

we

> can't afford to pay out of pocket. We received a letter of medical

> necessity from our doc today and plan to appeal charges for the

last

> two months as well as getting future visits approved. In the

> meantime, my son has been without therapy for a month and probably

> won't be returning unless UHC decides to approve future visits. So

> frustrating. I don't see why I should have to go to a facility who

> has such limited experience dealing with this problem when I can

go to

> one that has so much experience. There is no comparison in the

> quality of care that can be provided to my son by going to the

> children's hospital. The letter my doc wrote stated just that.

The

> " out of network " hospital has also agreed to accept whatever

payment

> UHC would normally pay an " in network " provider so I can't imagine

why

> they would deny coverage for future visits. Let's not forget we're

> dealing with UHC, not exactly known for being fair-minded or

rational.

> Who knows what they will decide.

>

> #2

> Our policy has an " orthotics exclusion " as well, but the agent

> mentioned nothing specifically about " cranial remolding " helmets

being

> excluded. I gave UHC the helmet code my PT gave me so they could

look

> up coverage benefits specific to that. The UHC agent told me that

it

> came up as being a claim that would have to be manually pre-

approved

> by a committee that could take 2-3 weeks. Since I was fairly

certain

> they were going to deny coverage anyway, I went ahead and banded my

> son. I didn't want to waste precious time waiting for their denial

> while my son was steady getting older. Haven't gotten the denial

> letter for the helmet yet. I'm sure it's on the way.

>

>

> Has anyone had success with UHC on any level? Any tips for dealing

> with these people or how to successfully appeal a previously denied

> claim? Any info in greatly appreciated.

>

> Becky

> mom to Will (STARband 4-3-06)

>