Re: United Health Care in NC

[Guest guest]

It may help to mention to your insurance company -- or to ask your

surgeon to do so -- that this is " surgery for the repair of a

congenital skeletal abnormality. " That is, repair of a deficiency or

excess in the upper and/or lower jaws...

Cammie

>

> Hi everyone... my upper jaw and bone graft is looking like it is

> going to be this summer so I am already getting nervous about

that.

> I am getting all of my upper crowns and bridges taken off up top

next

> week and getting temps put on which I will be in for well over a

> year. They are putting braces on that and then after all of the

> surgeries I am getting implants and new bridges. Anyways... it is

a

> long road ahead... but here are some questions that I have.

> Has anyone in NC (Triangle Area) used Dr. Sacco?

> Also, does anyone have United Health Care insurance?

> My dr is out of network and was curious how that works.... My

> insurance covers 50-80% out of network, and they cover oral surgery

> if it is due to an accident.. mine is simply genetic.. I was born

> missing 10 permanent teeth. So anyways... lots of questions.. the

> battle with insurance has begun by simply submitting my info

through

> my dr. so we shall see...Any advice would help!

> Thanks everyone!!!

[Guest guest]

I am currently in appeal of a denial from UHC NC. Don't compare my

situation to yours however. I need a lower advancement and shift

left, they denied saying orthognatic is excluded in MY PLAN except

for sleep apnea (which I don't suffer from).....my appeal is based on

the fact that that same exception allows for treatment of TM joint

disorder (which I do have).

There are too many variables to get worried about UHC until they

evaluate your case. 1) your plan may be different from mine (group

choice) & 2) your need is much more involved and congenital (see

Cammie's post). I would suggest that you pull out your policy and

look specifically for orthognathic, TMJ, congenital defects,

etc...pay particular attention the the " exclusion " sections. If you

don't have a copy, ask the plan administrator at work for a copy or

you could try. myuhc.com

Don't know Dr. Sacco, I am in Wilmington and UHC required that my

oral surgeon be not just a DDS but a MD as well, the closest I could

find (that accepts UHC) was at the Chapel Hill Dental school. Dr.

Blakey is supposed to do my surgery, if I can ever get it

approved!

Good luck,

[Guest guest]

Hi.

I also have UHC. I am in NY but they were very VERY difficult. you have

to stay on top of them day and night. They " lost " my first appeal. then

they told me I faxed it to the wrong # and gave me a different # which

was actually, the wrong #. They EVENTUALLY found the first one I faxed

when I demanded they look into it. It was apparently gathering dust for

3 weeks in the incoming data room... no-one had filed or entered it.

They delayed, postponed, were unaware of, not up-to-date with every

single possible thing. I could write a SAGA about the issues I

encountered with them. If they are inconsistant with information, call

them on it. It is the uninformed people who answer the phone's job to

NOT get you what you want. If they can stop your inquiry at that first

stage, they are most happy. Always specifically ask to speak to a

supervisor. If they do not immediatly transfer you, that is grounds for

firing... that is their company policy... I learned that after I

reported them to the Dept. of Health... but you HAVE to specifically

ask for the supervisor (and that persons supervisor as well, if you

feel so inclined)

Keep dates, names, conversation info and telephone call reference #'s.

I have an entire binder of information. Also, if you feel the system is

specifically working against you (in my case, losing and delaying my

appeal more than once... plus other problems) do not be afraid to

explore your options. I was so beaten by their system I called a local

lawyer who deals with insurance issues specifically. He told me a lot

about options, including Human rights groups for support with this type

of thing. In my case, I was told before I signed up that my surgery

would be covered but then was directed to a state plan that actually

would not cover it. Turns out the Gay Men's Health Crisis had a rash of

similar problems with UHC signing them up for this plan and then not

actually covering their needs. Just having that knowledge gave me power

because it was a real fight and it was nice to know it wasn't just

little me against a big, mean system that seemed to be working very

hard against me.

Good Luck!

T.

>

> I am currently in appeal of a denial from UHC NC.  Don't compare my

> situation to yours however.  I need a lower advancement and shift

> left, they denied saying orthognatic is excluded in MY PLAN except

> for sleep apnea (which I don't suffer from).....my appeal is based on

> the fact that that same exception allows for treatment of TM joint

> disorder (which I do have).

>

> There are too many variables to get worried about UHC until they

> evaluate your case. 1) your plan may be different from mine (group

> choice) & 2) your need is much more involved and congenital (see

> Cammie's post).  I would suggest that you pull out your policy and

> look specifically for orthognathic, TMJ, congenital defects,

> etc...pay particular attention the the " exclusion " sections.  If you

> don't have a copy, ask the plan  administrator at work for a copy or

> you could try. myuhc.com

>

> Don't know Dr. Sacco, I am in Wilmington and UHC required that my

> oral surgeon be not just a DDS but a MD as well, the closest I could

> find (that accepts UHC) was at the Chapel Hill Dental school.  Dr.

> Blakey is supposed to do my surgery, if I can ever get it

> approved!

>

> Good luck,

>

>

>

>

>

>