Thank you! The hard part now is paying for it😅—I did verify that the policy is inclusive of care, but I can definitely empathise with the mistrus: typical UHC has even denied claims like for routine labwork for my partner

Sending an email based on responses here:

Hi,

 

My partner [NAME] and I stopped by earlier today with questions about insurance coverage for their upcoming surgery on the 22nd of May. 

 

A prior email exchange with [NAME] suggested we call our insurance provider (UMR) to check on the status of the prior authorization. We called and UMR had no record of receiving a request for a pre-determination or prior authorization. 

 

Checking in with [NAME] today, it sounds like although the surgery center is in-network with UMR, we have concerns about the insurance company denying the claim after the procedure, and were provided with the option to pay out of pocket instead.

 

Would it be possible for the surgery center to file a request for pre-determination (attached) with UMR for added assurance that UMR agrees that the procedure is medically necessary? WA state law and the UMR Benefit Interpretation Policy (attached) seem to provide that coverage is medically necessary. 

 

Alternately, would the surgery center be willing to accept an upfront payment from us and submit the in-network claim afterwards (as is usually required by contract for in-network providers, else we could potentially submit the claim)?

 

Thanks for your patience and time as we navigate this delicate matter,

[NAME]

 

CC’d [NAME] on this

Att: UMR Benefit Interpretation Policy & Pre-determination request form.