Denied by both UHC & Anthem

WLS Not Covered by Anthem or UHC. I contacted both of my insurance companies; and both told me WLS are not covered under my plan. I check the Book and both have EXCLUSIONS. 1). Primary = Anthem BCBS Blue Preferred Primary Plus (POS) As of 2004 they have an exclusion: Related to weight loss or treatment of obesity. 2). Secondary = United Health Care Choice As of 2004 they have an exclusion: All Surgeries and Procedures related to Morbid Obesity. I can't believe it! Both Insurance Companys.. My Goodness! Now I have to come up with a plan B. I am so sad.

Cynthia, if Anthem says they don't cover weight loss or treatment of obesity, they MAY cover surgery to treat MORBID obesity. Sometimes it's about what they DON'T say!

I also have Anthem Blue Cross Blue Shield Blue Preferred Primary and my certificate lists under exclusions "We do not provide benefits for services, supplies or charges related to weight loss or treatment of obesity, except for the surgical treatment of morbid obesity". Each certificate of coverage is different, though. To be sure you need to call member services.

I believe Anthem excludes obesity surgery but will cover for morbid obesity. I would suggest calling your insurance company and having them send you a copy of the information. Also, in Ohio, House Bill 4 allows cardholders to an external review. Search for Ohio Department of Insurance (ODI) and follow the recommendations for an external review. They end up overturning 50% of the denials. Good Luck!

Cynthia, It may be in the wording that you are using. This is an expensive surgery that they will not want to cover. Obesity and MORBID obesity are two different things. Now I have heard from different WL surgeons that UHC will no longer cover this. In this case maybe you can make sure all the information is submitted AND THEN appeal. Like the Psych exam, visit to the nutritionist, letter from PCP, letter from surgeon, 1-5 years of DIET SUPERVISED weight loss attempts, and unsupervised weight loss attempts. Some that do cover it will deny because these things are missing. ANd even though you were denied because of these exclusions, If you have done and turned in the above info, with alll of these medical dr.'s referral and a high BMI, that makes your case look that much better and harder for you to be denied. I am waiting for approval from Anthem as we speak. Good luck/God Bless!