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For over a year I have called United Healthcare to try and get a GAP Exception in place as there are NO in-network doctors in Anchorage, Alaska - let alone Alaska at all.I filed appeals for services rendered in 2010 and they denied my appeals and GAP Exception request.

I was told that I will have to deal with it - cover the $1500 deductible and then 50% of medical bills for out of network providers.

How is this fair or right?Other insurance companies that I have had would consider medical providers as in-network if there were NONE at all in the state...

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Anonymous
#1146586

I would go straight to the employer on that one.If its a medicare claim, good luck.

You could negotiate with the provider of service and get the charges reduced to the in network level (what they would have paid).

Routine labs can be discounted as much as 70 percent.

I wish you all the best.

Anonymous
South Windsor, Connecticut, United States #1146585

As a choice plus member, you usually have a bit more leeway.Being in Alaska, there should be someone from each specialty in network within 30 miles of your home (max 50).

If not, then they have to give you the gap exception. The problem with those is that if things are not submitted exactly as they are on the gap, then they will deny it. That is why I put all possible codes that they could use and get them on the gap.

If this a commercial plan, you can go straight to HR and ask them to consider it...It is known as a direct appeal.

This might be a little late, but I certainly hope this helps.

Anonymous
#542823

Hello,

I am in the same boat like you with my $6,877 claim with UHC.

What did you do further? I did second level appeal with them and got the same above result.

Appreciate your help.

Thanks,

Subodh

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