Desperately need help: UHC, surgery, pre-auth denial
I have UHC, I am in need of a cervical fusion. I am scheduled for surgery in a week or 2 now. But UHC denied the claim “not medically necessary”. We appealed the decision and that’s in process.
On their online portal there is a benefits and care section. It asks me to log in and shows me all benefits covered under my plan and the codes I was given are covered.
On the portal it says: “You do not need to get prior authorization before getting this care”. No one can explain to me what that actually means.
Also: I have already spoken with an attorney who has agreed to represent me if they deny the appeal again. He strongly urged I try to work it out with UHC before he gets involved.
I am working with my surgeons medical coordinator/billing team and United. Any advice to get them to do the right thing without this taking 2 years and a federal ERISA lawsuit?
Also it’s about $35,000 between the doctor hospital anathesia etc is it worth just paying for it and trying to then go back and recover?
submitted by /u/Elegant-Lie-3122
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