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Re: UHC pre-authorization strategy

Posted by sleepy-in-seattle on July 31, 2007 at 13:17:34:

In Reply to: UHC pre-authorization strategy posted by DarkStranger on July 31, 2007 at 05:19:13:

1. Having dealt with UHC in the past, it took me 5 months of active campaigning and threatening to get a written authorization for MMA+GA. I don't think there is anything you can do in 9 days.

2. The fact that your surgeon is requiring cash up front is that they do not think the chances are high they will be reimbursed for the procedure. Maybe they've had recent experience with this being denied.

There is evidence out there that MMA+GA is significantly (more than a few percent) more effective than MMA alone. But your job is to find it, or have your surgeon reference it in a letter of appeal.

Unfortunately, you may have to cancel the procedure. I've learned to NEVER schedule surgery until I have a written authorization. Last summer, I had a nasal procedure scheduled for three months away. I figured I had plenty of time. Then due to the sugeon's schedule, I had to move it up by 2+ months. The authorization came the day after my scheduled surgery, and I had to cancel the day before.

If you don't have written authorization, then it makes better business sense from the insurance companies standpoint to deny, deny, deny.

I know how tough it is to get this close, but unless you are willing to take the very real risk of paying the entire $5100 yourself, you should probably abort and reschedule once you have written authorization in hand.

Good luck - Gordon

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