Were you intially denied the J-Pouch by insurance but won the appeal?

I've never heard of this, though perhaps others have. This is despicable behavior on their part. J-pouch surgery is standard treatment, so UHC is unlikely to fight very hard. The steps for this usually go something like:

1) Your doctor talks to the appropriate person (usually a "medical director") at the insurer to make the case. If that fails, 

2) You follow the appeal process UHC has in place. It may help at this stage to have a letter from your doctor. If that fails, 

3) Submit an appeal to the insurance regulator in your state. I've had success with this step when the others failed (in my case it was for VSL #3 DS coverage). You do need your ducks in a row, though, with a clear medical argument made.

Good luck!

I have also had difficulty dealing with UHC for coverage of medical supplies.  To date, I have gone thru two appeal levels and had my employer’s HR department attempt to get positive results.  My application for an outside agency review was rejected, so my final attempt is with the state’s insurance commissioner.  I suspect that UHC has spent more internally fighting my claim than the reimbursement amount I am requesting (and they state in their correspondence, “Your satisfaction is important to us.&rdquo.  Unfortunately, appeals are sometimes necessary to get the benefits that your high premiums entitle you to.  Best of luck with your appeal!

Oddly,

I was denied coverage on my J-Pouch construction (stage 2 of 3), but they were fine with the colectomy and the takedown after that surgery was done (it was pre-approved, then cancelled).

I worked with the surgeon's billing office to file appeals, and when they didn't work, the surgeon took the case to the state medical board.  I was just notified today that we won.

I don't really know what happened, or why, but it was great having my surgeon's office in my corner.

Glad you won. However, it sure seems ridiculous to me that your doctor was even compelled to do this. Nobody goes to medical school, residency and fellowship to fight battles with insurance companies. Plus, the ladt thing you need when you are sick! Sort of a pet peeve with me when bean counters interfere with recommendations of your physician.

Maybe during open enrollment it will be time to take your business elsewhere. This outfit sounds terrible!!

Jan

My surgeon and his office are pretty awesome.

I got a bill from them after the denial for some obscene amount of money, and the whole process was painless on my end after I called them to find out what was up.  When the appeals were denied, the billing office rep I was dealing with said, "I've never seen Dr. X so angry.  I don't think you have anything to worry about."

I'm grateful to that man for a lot of reasons.

And, my work insurance actually just switched to a new provider, and this provider is honoring the yearly out of pocket numbers from the previous provider.  Color me stunned.

UHC paid for my operations in 2010 but that was 5 years ago.

I'm disabled and on Medicare now plus my husband is paying for UHC as my supplemental insurance.

I have had many problems with the supplemental insurance. For example every time I go to the Mayo Clinic they have to run the claim again as UHC says they didn't get the claim. I have to call them every time and ask for them to run it through again.  Mayo says that I need to do this every time now.