Success with State Appeal?

[Guest guest]

Hi all,

I have exhausted my options with the UHC appeals process after the denial of

coverage was upheld after our 2nd level appeal. We have the option of appealing

and filing a grievance with the state insurance commission.

Has anyone here done that and has anyone been successful at that level?

I am sending our grievance tomorrow and am curious what others have experienced.

Thanks!

[Guest guest]

We filed a grievance with the insurance commission after the first appeal was

denied, but it didn't help. We have a specific exclusion in our certificate of

coverage that is keeping us on what seems a dead-end path to getting any sort of

coverage or reimbursement. I haven't received our official denial on the second

appeal, but I already know it is coming. We've been working with the rep who

handles benefits for my husband's employer and all his attempts have failed. He

has told us that if there is a specific exclusion, UHC will not make an

exception. We even had our state senator protesting the insurance commissioner

on our behalf. Still, no luck because of that exclusion. It seems there's

nothing left to do and we are on our own for payment.

Hope you have a better outcome.

Jill

Cade's mom

Texas

>

> Hi all,

>

> I have exhausted my options with the UHC appeals process after the denial of

coverage was upheld after our 2nd level appeal. We have the option of appealing

and filing a grievance with the state insurance commission.

>

> Has anyone here done that and has anyone been successful at that level?

>

> I am sending our grievance tomorrow and am curious what others have

experienced.

>

> Thanks!

>