UHC – Surgery approved but now they’re denying it…5 days before???

Hi, I'm sorry, I'm new here and desperate. I have had this surgery scheduled for four months, and five days before it's supposed to happen UHC is trying to deny the prior authorization based off of missing one test that was not performed (because my provider explicitly said the diagnostic criteria no longer required it). HOWEVER, I received an approval letter from UHC 8 days ago. This letter and authorization is still in the portal, and I haven't received any denials for this. My provider did a peer to peer yesterday, and they're being told they can't even do an expedited appeal because the medical director at UHC is outright denying it.

This surgery is out of state for me, and I had waited until I had the approval letter to book travel because I was afraid of something stupid like this happening. It looks like in Ohio (where I'm at), this might be illegal for UHC to do? Does anyone have any insight? My provider's surgery scheduler said she has never encountered this in the 17 years of doing it.

I am the subscriber of an employer provided HMO plan.

submitted by /u/Living-Lake-1791
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