Help! UHC denied me!

I called to check the status of my claim and the lady I spoke with in care coordination said that it was denied because there is an exclusion in the policy. I called and spoke with 2 different people before I applied and they both said that it was covered if it was medically nessecary. She said that I could appeal it. How do I do that? I have no idea what to say or how to say it. Dr. Daly's office is closed so I don't know if they can help me or not. Can anyone tell me what to do? Thanks everyone!

Marcy, a lot of insurance companies these days are denying people the first time around no matter what. Don't let this discourage you too much! The first thing to do is contact Dr. Daly's office in the morning and get a copy of the denial paperwork from UHC. It will state unequivocally why they denied you. Obviously they are stating that they don't feel it is medically necessary for you. The denial paperwork will give specific examples so that's the point that you will need to start at. If all else fails and you don't have anything else to go on, check out the legal help available to you at obesitylawyers.com! Best of luck to you. Don't get too down, you still have plenty of chances to fight them! Kelle

Went thru the same thing with UHC two months ago. I had no employee handbook. I called UHC Customer service and they said YES the surgery is covered if medically necessary. I wrote down the date and persons name. (they only give first name and last initial). I called again twice more with surgery code fromdoctor to make sure and customer service said YES it is covered under this policy. Doctor faxed the medical letter and bam! rejected from care coordination due to an exclusion. I called Customer service asked for a supervisor and they said yes it is covered, I called care coordination and they are nasty saying there is an exclusion. I hang up the phone in tears. I call my employer - they finally get me a handbook. Yes there is a written exclusion no weight loss surgery period. I rant and rave and contact the insurance commissioner for the state of Georgia and filed a complaint. I then get in touch with my employers UHC agent and threated to get an attorney. I wrote a poignant letter to the UHC regional person from the bottom of my heart expressing my remorse at something that was an error made by THEIR Customer Service Office. I Told them I was going on information obtained from their office. The Lord must have looked down on me because in about three days I got a call and they decided that since they kept saying it was covered, my case fell into a "grey" area. They approved me. You need to stay on their case unrelentlessly.

My insurance is throught the City of Alpharetta. I am so frustrated! I called and spoke with Caroline at dr. Daly's this morning. She said they did not have anything from the insurance yet and would call and ask them. They have yet to return her call.