OH Members I need your help!

Hello All, while I am new to posting messages I have been a member of OH for a while. Well to bring you up to speed with my case I have UHC insurance. There is a WLS exclusion. I have been working with the Director of my HR to find out if there is a "rider". Well yesterday I received a call from the Director of HR, he had this to say: After talking to one of the "big wigs" at UHC he was told that UHC across the United States has a WLS exclusion so in other words no one that has UHC is able to get approval for WLS reguardless of the medical necessity! I told him that I did not believe that this information was accurate. My director of HR then told me if I could find someone that has had the WLS this year through UHC then he would work on the exclusion and try to get a better plan through UHC. Apparently we have a flexible plan through UHC that may be changed at any time. This is where you come in! If there is anyone out there on OH land that has gotten approval through UHC in 2005 could you please email me!. Thanks in advance for your help! Dena T.

Hey Dena, My husband is from Leesburg...Did you grow up there? Steve, my husband, still has family there... Good luck w/ UHC.... Hugs, Jen W. 304/261/150

Dena- If you will go to the top of the page and click on insurers --then click on Florida -- then click on "U" then scroll down -- you will see the listings for UHC. It shows 727 listings for "U". But if you will then go to the bottom and and then click on "9" and then "15" that will get you some of the more recent listings. I did this and found some UHC approvals for 2005. Or you can just scroll through the whole list. You will see the person's name listed -- if you click on their name-- it will take you to their profile where you can send them an email for more info. Hope this helps. Red

I think Neil Intindola got approved through UHC, but I'm not sure if it was 2004 or 05. Erika L

Also: Ruth Santos in 2005 and KiminJax in 2005

Dena, I just spoke with an employee at my office who was approved for WLS (for LAPband none the less) with United just last month, her surgery is scheduled with Dr. Jawad in Ocala for later this month. I wouldnt believe what you are hearing. If you have a surgeon, lgo for your consult and et them go through the motions with the insurance company for your approval, at least get the ball rolling, then worry if you get denied. Good luck! Amy

Thank you guys for all of your help! I plan on keeping my appointment with Dr. Jawad of course. Thanks Dena T.

Dena... I hope you got my email. When is your appt. with Dr. Jawad? Debi.

UHC covers WLS, as long as your company bought the WLS rider. It's like when you are buying a car, you can buy the cheaper model, or you can pay a little more and get things like a sunroof, CD player, power windows, etc. Insurance is the same way, UHC creates a policy based on how much your employer is willing to spend for group coverage. I was approved for WLS through UHC, but mine was approved in 2004. ~ trish

It also depends on they type of policy the company has, meaning if they are fully insured, or self funded. This is the message I received from our broker about our written exclusion: "I can promise you that Park Square will never be able to offer this benefit under their United Fully Insured Contract. United Health Care still has in-force plans out there allowing this procedure but ALL of those plans written in Florida will be phasing out this benefit and it will become an exclusion as those existing groups renew. This is for fully insured companies which Park Square is. If there were a company that was Self Funded, then they can pretty much cover what ever they want because the money is coming out of their pocket and they take over most of the financial risk. The customer service # you called could be correct in saying that gastric bypass is a covered benefit for many plans, however, that includes other states as well as the remaining plans in Florida. I was told by my contacts in our local office and corporate that ALL plans written in Florida will eventually have this exclusion. They will be phasing them out all over the country but it's a timely process. Right now Park Square Homes has nothing to do with this exclusion and cannot make ANY exceptions. This is something that will NOT be offered at renewal or going forward as long as they remain under a Fully Insured Contract. United will NOT write any new business or renew business in Florida for Fully Insured Companies allowing this procedure. We are going through our renewal right now at J. Rolfe Davis and one of the first things I did was look at our exclusions to see if it was listed and it was (and it was covered last year)." Debi.