UHC/Definity letters posted plus some advice that applies to all ins issues

[Guest guest]

Hello everyone!

I've posted the appeal letters we wrote to get coverage for our son's

helmet (STARband). (Thanks in part to help from other letters posted

here! thank you everyone!)

We were told by UHC that is was denied yet when the orthotist's office

submitted the claim it was magically covered (4 weeks later b/c of the

snail's pace at which UHC operates)!

So I cannot say if it was due to

a. the letters

b. my persistence and multiple calls

c. the appallingly poor organization of the UHC system where it seems

claims are approved and denied based upon whims

some advice:

1. Keep a log of every call you make- note the CSR (customer service

rep) name, department, what they told you. Also note what action you

took. This will keep a time line b/c it will get very confusing after

several calls/appeals/dr visits (plus you have an infant- you're

already exhausted!)

2. If you think that they are giving you incorrect information, ask to

speak to their supervisor or call back later and ask the same question

of the CSR that takes your call. You would be amazed how frequently

people will tell you incorrect information just to get you off the

phone or b/c they don't want to say 'I don't know, let me ask my

supervisor "

3. If you forget to keep a log- don't worry- they've kept one for you.

Ask them to read to you the dates and people you spoke to. I spent 45

minutes on the phone with a very helpful CSR in the 'rapid resolution'

dept. She was very happy to tell me who told me what incorrect

information was passed to me and by who (first and last names!) and

actually apologized several times for what she called 'inexcusable

incompetence due to poor training and high turnover rates.'

4. your employer is a great resource for help with finding wording of

your policy- don't let them tell you it will be 30 business days to

send you your summary plan description via snail mail. SOMEONE has it

at work or can fax it to you.

5. Don't wait for things to come in snail mail. Request faxes of

letters or authorization numbers. I've been told letters are in the

mail only to receive them 14 days later. It does not take 14 days for

mail to get from Ohio to Rhode Island.

6. Be persistent but be nice. Kill with kindness. Genuinely thank

people who are helpful- they probably don't hear thank you very often.

Basically remember that the ins company works FOR YOU not the other

way around. hang in there and GOOD LUCK!

-Allyson