MMA insurance appeal
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MMA insurance appeal

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Posted by JimW on July 15, 2008 at 08:42:32:

I scheduled MMA in next week with a well known Doctor frequently mentioned in this forum.

It was approved by UHC for MMA but only as out of network. I called UHC for the Gap Coverage, they refused me and sent a letter with a list of doctors in network which UHC thinks can do this type of procedure and they are in my area. I contacted all them (5) specifically asked if they have done this surgery relates to OSA, according to the advises I got from this forum. One of them directly said no. One said he does no do it currently and he knows somebody does it. One said he does it but frankly confess he graduated in 2005 as I asked how long he started doing OSA related surgery. Another one tried to convince me the principles are the same for treating OSA and other facial constructions. He did not give me the number of his patients he treated for OSA, only informed me he started doing THESE surgeries since 2002 when he graduated. He would not give me a patient reference even though I asked.

Of course I will still go to Stanford. My problem is how can I appeal to UHC. It seems I cannot say there is nobody in my area can do this type of surgery even they are not as experienced as Stanford doctors. Any advise about this? Thanks a lot!

James



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