Tuesday, January 29, 2008

Interesting

Interesting bit of news ... when the person from Mark's HR department asked their UHC rep where the exclusion they came up with is found, the response was, in effect -- we can't share that information with you. What the hell!? Why does UHC think it's "confidential" information they don't have to share with their own customer? Especially in light of the fact that the second level appeal is with Mark's employer. You'd think they would be allowed to know the basis of the denial they will be asked to overturn. Mark's HR person told him that we just need to go ahead and appeal. I'm really glad I have an attorney involved (one who knows this area of the law inside and out). The appeal hasn't been filed yet, but, hopefully soon (before I have to get pushy).

I heard back from Jack's ophthalmologist: "if you think he is using the bifocal, then I would continue it, particularly if he is looking at things both near and distant. In some children who spend the vast majority of their time looking only at things within arm's reach, we use single lenses adjusted to focus at near. To make a decision it is important to know what the patient does in real life."

Real life -- that's the one little detail the ophthalmologist here didn't take any time to find out about. Looks like we'll be making that trip to STL. *Sigh*




2 comments:

julie w said...

That is really stupid, if they can't tell you where the exclusion is - their customers should have a list of exclusions! Hope you get the appeal lodged soon.
Glad you heard back from the opthalmologist, sorry you are going to have to make that trip though
(((HUGS)))

Melisande said...

Hope you get an answer soon!!