Starrfish
New Member
- Joined
- Jan 12, 2016
- Messages
- 3
I had what I hope is a quick question, that's been confusing. I have UHC PPO choice with what I was told is an exclusion for wls on my policy. I also have medicare (a&b). We were told by medicare it had to be submitted to UHC and receive a denial and have the surgery before they could process to medicare. Last I heard from Trevor was that he was submitting to UHC and a denial was expected by the end of the day, and I could then set my surgery date. Well, after not hearing from Trevor for nearly a week I called to check the status. Kayla read me Trevors notes on my file. It stated he had submitted the initial case, they replied requesting additional clinical info on my comorbidities, which he then submitted late Friday afternoon. Kayla couldn't tell me if it was UHC or Medicare that the notes where regarding. My confusion is after looking at my UHC plan and claims, my plan doesn't specifically state "excluded" but there has been nothing showing up in claims. Medicare doesn't do prior auths, so is it possible my UHC is reviewing my surgery? I'm sure some of this could be cleared up by Trevor, but it's near impossible to get him on the phone. Thanks in advance for the advice.