Not so good Tuesday! Denial, crying and depressed!

Well, I have UHC and I called before my first consult and was told that I will be covered at 90% with no co-pay. I went to the consult and did all I had to and when the surgeon called they were told it's not a covered surgery. So I called UHC and I was told, it is a covered procedure under my policy with medical review. So my surgeon submitted and one day later I was told I'm denied becuase there is an written exclusion in my policy. So I call UHC and again am told, i'm covered for 90%. I finally have had enough and told them I can't get a direct answer from anyone there! I was then told after it was medically reviewed they determined that I was denied but I could speak with the Care coordinators becuase thats who denied me. So i was transfered and when I talked to the care coordinator I was told that it had not been medically reviewed. THere is a written exclusion on my policy and I"m denied. Anyone else had this problem? Ever been approved after being denied becuase of a written exclusion. My surgeon is saying if the true reason is because of a written exclusion we can appeal but I won't be approved. I am now waiting on the denial letter to see what exactly it says so I can go from there. I"m sitting at work crying right now because my hopes were so high that I would have been one of the easy cases. Guess not

Vicki, You should have a benefits booklet and you can read in there yourself what exclusions you have. I would agree with your surgeon that if it's a written exclusion, it's very unlikely you will get it overturned. The only other thing I would say is that many patients are surprised by how much their cost-of-living goes down after the operation, so it might be worth looking into self-pay. It's better to spend $250/month on an operation to improve your health than $250/month on eating out and weight-related medications! Good luck, Dr. C

Hi Vicki, I can totally relate. Read my profile. I was told the same thing, covered at 90%, & paid for a psych eval & sleep study & then was told that it was a written exclusion. Written exclusion means no way, no how! So, i went & got a different job. I live in Grove City too, I have a list of companies that will cover it if you are willing to go that route. Don't give up if this is truly your dream....Make it happen! Darlene

I have been trying to get an exclusion overturned for about 2 yrs. I am about ready to try another job also. Would it be possible to get some info on those jobs that have the insurance that covers the surgery? Thank-you! Shelia

I compiled this list from December, so I'm pretty sure it is still accurate: Home Depot (pt employees get benefits after 3 months I think) Cracker Barrel (I think at least 32 hrs per wk for 6 mos to get benefits) Columbus Children's Hospital (pt benefits from day 1, but insurance only covers WLS at 50% with a cap of $12,500 Time Warner Cable (pt benefits I believe) SBC-AT&T I think I have a list of more somewhere if you are interested Darlene

After many hoops jumped through, I also went the self-pay route. I didn't feel as though I "deserved" to spent that kind of money for surgery, until we went shopping for a new car. I realized while sitting in the dealership that I was worth more than the cost of a used mini van! I had the lapband done Feb. 13, and I'm down 83 lbs. today. Best money I've ever spent. I just didn't buy WLS, I bought a future for myself and my loved ones! (My surgery cost 13,900. at Barix in Groveport Ohio)

Hi Vicki Sorry you're having so much trouble. Is your UHC through the state of Ohio?