United Healthcare Decides You Only Needed Second Of Two Procedures

The good news is that after having two procedures on her spine last fall, Jackie is able to walk again. The bad news is that even though the two procedures were identitcal, United is only paying for the first one and not the second, and won’t actually explain why. She has appealed the decision, but things don’t look promising.

I had two identical procedures performed on my spine. One 10/28/10 and the second 11/28/10. United Healthcare covered the SECOND one but denied the first one and is sticking me with the bill. Remember, these were identical procedures. I got the run around that my doctor didn’t code correctly, then there was the ‘not enough medical proof’, then the ‘not deemed necessary’, etc. There were many many excuses.

United Healthcare has a 36 page medical chart that is mine that they claim they don’t have, yet I have proof that they received it. HIPPA violation anyone? Yet they still say they don’t have enough information. My doctor requested a peer to peer review and United Healthcare won’t call them back if it was to save a life. Ridiculous.

Today they told me it has been denied and my only recourse is to appeal, which I am doing. But if they decide to say no AGAIN, I will be stuck with a $1400.00 bill because United Healthcare decided what was best for my health.

Thanks to the procedures though, I am able to walk again.

Health insurers are large, terrifying bureaucracies with great power over our lives and our money. Oher readers have been able to put a human face on United and get help by calling the consumer advocate hotline at 1-800-842-2656. Other readers have been successful with an executive e-mail carpet bomb, if you need to take your case to a higher authority.

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