United Health Care Insurance Problems

Hi everyone, My son Shawn was scheduled to visit Pittsburgh on Sunday, December 10th to get diagnostic testing for SIR spheres. We were told that UPMC was out of network for United health care. We are now looking to see if there is anything around the Boston area that this procedure is done and the big question is whether it will be covered by his insurance, United Health Care. Can I get some feedback on this subject from everyone as to whether anyone that has had the treatment was covered by United Health Care. I cannot get any answers from the customer service department of united health care. This is very frustrating for us. I have spent the last week setting this whole thing up and now I am back to square one. This treatment is our only hope as Shawn has gone through all of the chemo without success for over a year and a half. Any help would be great. Thanks, Diana

The customer service folks at any insurance organization only detail benefit coverage. They are not capable of understanding the importance of facilitating treatment with an out-of-network provider. I would contact United on Monday and ask to speak to a case manager.

Case managers are generally nurses who have the ability to look at "the big picture". They will assess, plan and facilitate quality, continuing care services while advocating for the best quality, most appropriate care for your son.

Additionally, you have the RIGHT to appeal any benefit determination that United makes regarding your son's care. Make sure to ask United for written information about making a benefit determination.

 And, finally, the Patient Advocacy Foundation may be able to offer additionally suggestions on how to challenge the system. You can contact them at www.patientadvocate.org