United HMO denial
Hi Riley, I don"t have your insurance, but I was denied twice by Aetna. I had the Doc that is doing my surgery appeal the decision and again I was denied. Then wrote the company and was honest and told them that this was my last option and that my comorbidities would not get better if I did not have WLS. After this letter was received, I was approved. Maybe if you write the insurance company have your WLS doc and your PCP wroite letters again, you will be approved. I hope this helps and that you are soon approved to have your WLS. I will add you to my prayer list as I truely believe that prayer changes things.........Brenda from Apopka
United Healthcare HMO usually approves WLS. The exception to this is what you just heard of: Benefit Exclusion. This means that the company purchasing the group policy you have with UHC (your employer or some other group you belong to) has told UHC they will NOT pay claims for specific treatments. This is usually done to help keep costs down.
This surgery is gaining wide acceptance as a valid treatment for morbid obesity, however, and you should not only appeal with UHC, but you may consider getting some legal help and appealing to whoever (employer/other group) has declared they won't cover it. Sometimes they will consider it on a case by case basis..... sometimes legal representation will help change there mind. I know somewhere there is a lawyer suing people who won't cover it and the lawsuit is discrimination based on health conditions, which is against the Americans with Disabilities Act. Sometimes people have to be evaluated and declared to be disabled, which can have ramifications on insurance policies, etc.. but if it can help you get approved for surgery then sometimes you might want to consider it.
Good Luck.
for more legal information try www.obesitylaw.com
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