So confused, can anyone help?

I was denied surgery after Dr. Whitehead sent letter of medical nec. to UHC (choice plus plan) because of a written exclusion. I was told that my employer (Tulane) had to get a policy without the exclusion, but when I contacted Tulane's Human Resources, they told me that UHC does not have a plan that will do gastric bypass. I have spoke to people using UHC for their gastric bypass. I have called my "care coordinator" at United Health care about 50 times in the past 3 days, but they do not call back. Ms. Crawford(with Dr. Whitehead) says she will get a denial letter from the insurance company and then write an appeal. I have open enrollment for insurance in October, at which time I can meet with a UHC rep. but do I need to change my plan to another with UHC, or do I need to look into another insurance company. Also if I do get private insurance to cover me, how long do I have to wait before they will do the surgery? If any one has any answers for me I would so appreciate it. Also, anyone else going through the process that just wants to talk or vent, please contact me. I know there are others out there as frustrated as I am. Sabrena Poplarville, MS

Hi Sabrena, Janet is WONDERFUL (sometimes she is just terribly busy).... I talked to her today and cried like a big ole baby as I have done many times over the past few months. It took me 2 appeals to get approved. I dont have any advice about an exclusion but DONT GIVE UP. You are the first one on this list that is using the same dr as me. I feel so confident with Dr. Whitehead. I also want to tell you that before I was approved by insurance I contacted Vocational Rehab. They cover this surgery but you have to have a surgery date first. I had to call Dr. Salamehs office in Jackson and they gave me an appt for next Tuesday for my consultation. He does it laproscopic and as you know Dr. Whitehead only does it open. Dr. Salameh will want you to have several things done that Voc Rehab wont pay for. I already had my pscyc eval and nutritionist visit. He wants a sleep study done and I called yesterday for my OB to make me an appt for sleep study. The reason I had my OB do it is so that Ins wont deny paying for the sleep study since it would be weight related. That was an idea I was given from someone on this list. (I dont know if she wants me to say her name)... He would also want some other things but I cant remember right now what all it was. Its an OPTION you have. The money is available. I cancelled my sleep study today because I was approved today and I need to call tomorrow and cancel my consultation with Dr. Salameh. I just fear that you wont get any where with your insurance if its an exclusion but I have no idea. I hate exclusions. I know exactly how you are feeling right now. Trust me I know its awful. If you need anyone to talk to -please feel free to call me. I can give you both of my appeal letters if you want. Good luck to you. Try Voc Rehab. I wish Dr. Whitehead took this. Just dont give up. I almost did and I am approved now and its the best feeling in the world. Fight tooth and nail. Read my profile- Its full of all my frustrations.

I think Dr. Roger Blake at the University Hospital in Jackson Is the only doctor that does vocational rehabilitaion in Mississippi.

And his partner, Dr. Salameh.

Dr. Salameh..who is ABSOLUTELY WONDERFUL and specializes in laparoscopic surgery...also takes Voc. Rehab. He is my surgeon. He is Dr. Blake's partner and is the one that taught Dr. Blake how to do the surgery laparoscopically.

Drs Salameh and Blake are not partners. Both are employed by UMC, individually. Dr. Blake learned how to perform lap bypasses during his residency in Dallas and Dr Salameh learned during his fellowship in Houston

Oh well... any which way it is-- Dr. Salameh takes Voc Rehab.

Both Dr. Blake and Dr. Salemah take Vocational Rehab. As for the UHC policies: There are UHC policies that cover Bariatric Surgery. I don't know where the HR department got their information. We have patients that have UHC and are approved as it is NOT an exclusion in all UHC policies. Yes, some policies have the exclusion, but it is generally the Employer that chooses which policy will be offered to their employees. I would fight this one with your Benefits Coordinator at your place of employment. If there are more employees interested in Bariatric Surgery, get together with information, statistics, etc and go to the Benefits Office. I'm sure your Surgeon's office can help you get that information together to demonstrate the importance of Surgery vs. No Surgery and the problems that continue and worsen with no surgery.

Just gonna say hi and hang in there. I think everybody has got you covered with answers real well. Smooch, Arlies