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United Health Care denying surgery

Started by Wcatmonster on 04/15/2017 11:20pm

I am wondering if anyone is having issues with UHC denying surgery for a lumbar fusion? I have had a mri,discogram,ct scan and flex n ext x-ray to prove my L4/5 and L5/S1 are bad. I've seen a chiropractor,done physical therapy, lumbar injection, si injection and trochanteric injection also and different pain medications and nothing has helped so surgery is my last option but the insurances denied my claim and 1st level appeal. I am working on my stuff for my 2nd level appeal now so i can file that. It bad when the insurance says you have no instability but your disc is slipped forward and the x-ray shows that and then they say you don't have a pinched nerve but you have pain down your leg plus two test that say that you having narrowing which caused pinched nerve and so does the annual tear where the leakage puts pressure on the nerve roots and spinal cord. Any info will be greatly appreciated.

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Hello, and thanks for sharing your question with the Community. We are so sorry to hear about your health insurance denial for spine surgery. It's incredibly frustrating when your insurance doesn't cover a procedure, especially when it appears you've tried more conservative therapies.

By filing multiple appeals, you're doing all you can to gain coverage for your procedure. We wonder if your doctor could help, too. Assuming your provider is in United Healthcare's network, perhaps he or she could help secure insurance approval of your fusion by submitting documentation expressing a clinical need for your surgery. Have you spoken to your provider about reaching out to your UHC on your behalf?

Keep us posted on what happens. We have our fingers crossed that your insurance company covers your fusion!

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Yes my Dr is a in network Dr and filed the 1st appeal and did a peer to peer review but still no luck so now I have to d a 2nd level appeal with my employer. It has been a rough 8 months.

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