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United Healthcare/IVIG no approval needed?


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Dr. K's office told me to call UHC/PPO to ask for pre approval. I called UHC and gave them the cpt codes and they said they don't need to give me pre approval/cert for this. And of course, Diane is gone for the day now.

 

Huh?

 

I do know Dr K and the surgical center are out of network for me.

 

I'm just so afraid of messing this up. So basically I won't know until I get a bill, is that it?

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Someone from Oakbrook handles the billing and they will make sure they know they are getting paid or they will collect the money from you upfront and you will get reimbursed later. At some point, you will get an email from his office on who and how to contact Oakbrook.

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Don't trust them, get pre approval out of network now. Pre approval in network should be ok but you NEED to check with out of network, they have messed with me at UHC on other matters.

 

M

 

But how? I tried pressing the woman on the preapproval line (not member benefits) and she stated flatly several times that it was not required.

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Will they send you a letter stating that they don't require preapproval for the specific procedure?

 

We had an experience where our insurance company told us we had met our out of network deductable (the online info showed that we had too) but when I submitted for reimbursement for an out of network provider, we were told we hadn't really met the out of network deductable and that they had corrected the error on the website (I wish I had printed it out earlier). We are now appealing based on being told incorrectly but I'm not sure how successful we will be. I wish I had gotten something in writing before we went through with the appt.

 

Don't trust them, get pre approval out of network now. Pre approval in network should be ok but you NEED to check with out of network, they have messed with me at UHC on other matters.

 

M

 

But how? I tried pressing the woman on the preapproval line (not member benefits) and she stated flatly several times that it was not required.

Edited by justinekno
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From here:

http://www.individual-health-plans.com/ppoplan.htm

Preferred Provider Plans (PPO Plans)

PPO plans are preferred provider plans. Health insurance companies contract a network of doctors and hospitals that are "preferred" by the company. These network doctors and hospitals charge a contracted fee for their services and when you choose to see one of these "preferred providers," the amount you pay out of your pocket is usually quite low. There is typically a small co-payment (a fee per visit or service), which may be $15 or $20. It is important to keep in mind that since the insurance companies keep prices lower by contracting specific doctors and hospitals, there is higher charge for going out of the healthcare provider's network. However, the PPO is a more flexible arrangement than many other plans because the plan will pay some of the costs if you choose to visit a doctor, specialist, or clinic outside the network. For example, if you want to see a world renowned specialist at the John Hopkins Clinic, your PPO plan would reimburse you for at least some of the cost.

 

So it sounds like it will be covered to some extent- but you'll end up paying more than usual. Of course this is not specific to your plan. How about instead of asking pre approval, ask how much of the cost they will cover?

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Dr. K's office told me to call UHC/PPO to ask for pre approval. I called UHC and gave them the cpt codes and they said they don't need to give me pre approval/cert for this. And of course, Diane is gone for the day now.

 

Huh?

 

I do know Dr K and the surgical center are out of network for me.

 

I'm just so afraid of messing this up. So basically I won't know until I get a bill, is that it?

 

I did not need preapproval with UHC. My doc is in network though so I don't know if it matters....

 

susan

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Dr. K's office told me to call UHC/PPO to ask for pre approval. I called UHC and gave them the cpt codes and they said they don't need to give me pre approval/cert for this. And of course, Diane is gone for the day now.

 

Huh?

 

I do know Dr K and the surgical center are out of network for me.

 

I'm just so afraid of messing this up. So basically I won't know until I get a bill, is that it?

 

I also did not need pre-approval/pre-certification from UHC, but we also used an in network doctor.

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Hello everybody! Long story very short, we're going in for IvIg with Dr K soon as well, and we have UHC. I am just starting into figuring out how to do this and if anyone has had success with UHC covering (or partially covering) IvIg with Dr K, I would very much love to hear it!

 

We're starting the steroid burst in the morning and are hopeful and curious to see its effects.

 

Once I come up for air, I'll post what we've been going through the past half year.

 

Hugs to all you mamas and papas out there!!

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I thought I heard somewhere that UHC changed their minds recently and that they decided not to cover IVIG for PANDAS anymore? Anyone else hear that?

Stephanie

 

Hello everybody! Long story very short, we're going in for IvIg with Dr K soon as well, and we have UHC. I am just starting into figuring out how to do this and if anyone has had success with UHC covering (or partially covering) IvIg with Dr K, I would very much love to hear it!

 

We're starting the steroid burst in the morning and are hopeful and curious to see its effects.

 

Once I come up for air, I'll post what we've been going through the past half year.

 

Hugs to all you mamas and papas out there!!

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Our experience with UHC and plasma pheresis, for BOTH daughters was as follows.

 

Doctors office calls UHC, and they say not approval needed. Docs office gives diagnosis and treatment code. Daughter is admitted- after procedure we receive a letter stating it is not covered - "experimental".

 

Hospital doesn't bill us right away, and in the meantime other dd goes into pandas crisis and needs pex.

 

Again, doctors office calls UHC, and they say pre approval not needed. This time hospital requires pre approval letter or no go. Ultimately, then, we ended up having to fight UHC for 3 weeks. Doctor and I talking with them daily- saying they are jeopardizing daughter's health. Finally we decide to put the money up front, and just get daughter relief. We pay $25k, after procedure, and a lot of fighting by doc, me and husbands HR - we get approval on both girls. UHC pays their in network rate of $5k each. Now we are trying to get our $20k back from the hospital.

 

Moral of the story- if you really need the insurance $$- insist on a pre approval. It will take time (if you can get it). Call every day, get the insuring company involved, ask Dr K to write a letter or talk to someone. It took us to the 3rd appeal.

 

If your child is in crisis, and you need to get this done. Admit them, get denied post procedure, and then fight with insurance and maybe set up a payment plan with hospital.

 

The surgery center may not even take you without a pre approval letter or code, though.

 

Insurance stinks!!

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Dr. K's office told me to call UHC/PPO to ask for pre approval. I called UHC and gave them the cpt codes and they said they don't need to give me pre approval/cert for this. And of course, Diane is gone for the day now.

 

Huh?

 

I do know Dr K and the surgical center are out of network for me.

 

I'm just so afraid of messing this up. So basically I won't know until I get a bill, is that it?

 

 

We have BCBS, but we had a similar response with no need for pre=approval--then, oh, wait....The pharmacy division is where the approval needed to come from. IVIG was an excepted procedure, but the pharmacy division had to sign off. There was the hang-up. Hope this is not the case for you. Dawn

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