Need some advice....

Hey everyone! Hope all is well with everybody! Now that I am caught up with all of all of my posts (I have been out of the loop) I have an issue that I need some advice on. I am in insurance hell right now waiting for approval, however, because of conversations I have had with my insurance company (United Healthcare) I will not be covered. I haven't received an official denial letter yet, but there is an exclusion in my specific policy from work that states "surgical and nonsurgical treatment of obesity, including morbid obesity not included." Bummer!! I haven't given up hope yet, there are still options, just wondering if anyone has been thru this and has any advise or any good words or wisdom. My HR dept said she would help if she could. I work in a pretty big place, I don't think they will change the policy just for me, but I will take her up on her help. Thanks. Love to you all! Phyllis

Hey Phyllis, I am the angel to a faboo woman in NH (my home state) and she is dealing with incredible insurance issues. She can give you some tips and words of wisdom. Her name is Karen Maria, look her up here on the board. She's an amazing woman with a ton of information for you. Best of luck! -Deb

Awesome! Thanks for the info! I posted an email to her and printed her profile to read. Phyllis

Phyllis-Sorry to hear about your problems..Good Luck Joanie

Awwww, geez. Just what you needed, right? Well, I would say that you keep on fighting for the reason of MEDICAL NECESITY. Appeal, appeal and appeal. Get some good convincing letters written by your surgeon, your PCP, your psy doc and any specialists you might be able to go see. Get them all to say how medically necessary this is and build you case for why they should cover it. And, you never know, your company might change their policy just for you. It's been known to happen. Barring all of that, can you change your insurance during open enrollment? Good luck to you. Lisa C

Lisa, It all seems so overwhelming, the whole appeal process. At least my surgery date hasn't been affected because of it - yet. It seems odd that a copy of over 300 has only one choice of insurances and when I was at the other lawfirm of 14, we have four choices. Thanks for the kind words!! Phyllis

Hi Phyllis, I can't give you any advice but I just wanted you to know how bad I feel for you. After all you have been through what a horrible let down. Good luck with your battle ahead of you. If you need anything I'll be here. Sandy

THanks so much Sandy, it helps knowing I can come here for advise and support! Phyllis

Usually, if obesity tx is excluded from the policy that is due to your employer. I would see if this is the case and then perhaps your hr person can help you get it approved through your company. Some companies exclude the insurance for obesity surgery so their insurance is less expensive. Hopefully, you can get an approval. Ask your hr person to see if who you should go to in the company to see if they will approve your surgery

Don't get too disapointed. I know of several people who were able to get approval even with exclusions. It does require some work and possibly hiring an attorney, but it can be done. Many employers don't really know the details, but if it is self-funded, I believe there are ways to get exceptions. Check out these 2 websites, there is info there on what's involved (I think) www.obesitylaw.com www.obesitylawyers.com I was given both adresses by my Dr office... Good Luck, Carmen