United Healthcare Gap Exception

triciajoy78

Has anyone delt with a gap exception?  I live in the Kansas City metro area and am receiving prenantal care at New Birth Company.  I have United Healthcare and have been denied a gap exception due to other "facilities" in my area.  The other "facilities" listed in the denial are three hospitals. My coverage does include birthing centers. 

Anyway...  I am appealing the decision now and I am looking for consumer rights relating to the gap exception.  Does anyone know of refrences for these?  I want to site my rights in my appeal letter. 

 Thanks in advance for any help you can provide!

 

pugznploons

I don't really have any advice.  I am also in KC and considered the birth center but ultimately decided on a hospital birth.  I wish you luck appealing it!  Personally I hate UHC.  My patients with it have extremely limited options for nursing homes (the ones in network with UHC are some of the worst in the city) and I have seen many patients with UHC think they have certain benefits but when it comes down to it, they do not.  

are you taking classes at the birth center?  I am planning on taking a couple there, I've heard most of them are really good.

 

triciajoy78

The facility stated that one mom won an appeal on a gap exception.  I hope I'm the next   I haven't signed up for classes yet, but will around 6 mos along.  Did you ever tour the birth company?  I was really impressed with the facility.  Which hospital have you decided on?  I pray I don't get transferred out for any reason, but I need to have plan b's in place

MsCat19

This doesn't personally make any difference for me at all, but please, please, please keep up your fight!  The only way things can change is by strong folk like yourself fighting for it.  Best of luck!!!

pugznploons

I hope you are the next!!

We haven't toured.  Dh would be totally cool with the birth center, and our insurance would cover it, but I just feel more comfortable with a hospital.  I've just had too many friends have a seemingly normal natural birth end up with a c-section due to complications that arose late.  Also I feel better having a NICU on site.

I am delivering at St. Lukes South.  Which hospitals are covered by your insurance?  I know OP Regional, Research, and SMMC are all very natural friendly, if you aren't able to win your appeal.  I would probably choose to transfer to OP Regional as they have the highest level NICU, and if you were being transferred out it would make sense to go to the one with the highest level of care just in case.  Plus it's just 5 minute away from the birth center.  

PineApple85

Call the billing office and pick their brains.  I work in a billing office and used to work exclusively with UHC and can say they are hard to deal with, especially on appeals.  The billing office, namely anyone with experience on an appeal like this would be a great resource for what will carry weight with UHC.

JFH2010

I don't have experience with the gap exception, but I can agree that UHC is the absolute worst. They have been a nightmare to deal with throughout my pregnancy. Just stay persistent and follow every possible appeal route available to you.

hillary1211

Were you able to get any "in-network" benefits after appealing? I'm in LA and my coverage only extends to hospitals and excludes all birth centers. I would love any information on navigating the appeals process. Should I just get new insurance and avoid UHC completely?