Can anyone tell me about getting approval from United Healthcare?

Hello. My name is Jaci(Jackie) and my insurance is with United Healthcare. There new policy book came out in Feb. 2005 and now has an exclusion for weight loss surgery. I noticed that some of the members have received approval through UHC since 02/05. Does this mean that it is possible to get approval even with the written exclusion? Should I go ahead and try? I really want to have weight loss surgery because I seem to be gaining more weight daily. It as started to affect me with severe back pain, ankle swelling, elevated blood pressure, and I had to have my gallbladder removed in April. Can anyone give me advise on how to proceed? Thank you.

I don't have very much to offer, but the question that makes a difference is not as much about "who is the insurance company" as "who pays the bills." If your company is self-insured and paying their own bills, they can have UHC write the policy any way that they want to write it- and the exclusions will stand despite UHC covering other people. But, when you start to fight it, you can go through your benefits manager or human resources dept to try to get the exclusion overturned if that is the case. FWIW Denise in FS

Hi Denise. Thanks for the info. I called my human resource manager this morning to see if the company had written in the exclusion and he said "no". He thought that was just a standard part of UHC's plan. He is going to check into it further because I explained to him that the old book(from Feb. 2005) said it covered weight loss surgery if medically neccessary. Is it good that it wasn't specifically written in by my company??

Jaci, I think your best bet would be to go to the main board and post this question about UHC. There will be a ton of people there who have your same insurance and can better answer the question of how it works overall. IF your company was self-insured and had written this exclusion into their plan, and IF you appealed to the the decision-maker and IF that person was at all sympathetic to your medical needs, they could override the exclusion. OTOH, I have heard a terrible horror story about how a woman's supervisor called her insurance company and told them to rescind their approval because the only thing she really needed to do was push back from the table. Now, that supervisor was WAY out of line on so very many levels, but that just illustrates the kind of fat predjudice that we meet sometimes. So much also depends on how the exclusion is worded. If it is worded where they only pay for wls with proven medical necessity, then that's not so bad. You shouldn't have any problems proving the medical necessity. But if their plan, like mine, says, " The Plan does not cover surgery for weight loss" then that's a pretty tight exclusion. You can still fight - and you should! Ultimately you can also look to self-pay. If I was going to do self-pay, I'd do it out of the country where it costs about 1/3 as much. The best doc in the WORLD for the duodenal switch procedure that I want to have is in Spain. There are questions to be debated about going out of the country, but by and large and with careful research you can get VERY good care from the best doctors in the world at first class hospitals. So don't give up now...it's way too soon. Keep butting your head against every door you can find, and eventually, one will open. Denise