UHC written exclusions/appeal letter?

HELLO ALL AND HAPPY NEW YEAR! I MAY BE JUMPING THE GUN, BUT I'M STARTING TO WORRY THAT I MAY BE DENIED BY UHC. I WAS WONDERING IF ANYONE HAS UHC AND HAD WRITTEN EXCLUSIONS IN THEIR POLICY AND STILL BEEN APPROVED? ALSO, DOES ANYONE KNOW WHERE I CAN VIEW A COPY OF AN APPEAL THAT WOULD GIVE ME AN IDEA OF THE INFO. THEY MIGHT NEED TO RECONSIDER? MY SURGEON SENT THE PAPERWORK IN DEC 1ST AND AS OF YESTERDAY THEY (UHC) HAVE NO NEWS FOR ME. I WAS TOLD IT DOESN'T SHOW IN THE SYSTEM THAT A REQUEST IS ON FILE, BUT THAT IT WOULDN'T SHOW UNTIL A DECISION WAS MADE ANY HELP IS GREATLY APPRECIATED! GOOD LUCK TO ALL US PRE-OPS AND CONGRATS TO ALL POST OPS! BEST WISHES FOR 2004!

Finally, I can help somebody. I was approved in November for WLS by UHC. It took them about 4 months to approve. I had a written exclusion in my policy as well but UHC will cover if surgery is deemed medically necessary. In UHC internal policy a BMI over 40 makes WLS medically necessary. All the info stated above is for year 2003...2004 info maybe different.

Thank you so much for the help!!!! I feel more at ease knowing if they DO deny me at 1st, there still may be hope. I had to laugh when you said "finally I get to help someone"....I feel the same, I'm always lurking and reading and asking questions and feel like I never get to return the favors. Someday I'll get my turn to help out my WLS family.

Hey there; I too am starting a battle with UHC, my husband works for Dade County Public Schools and they have an exclusion. But......there still is hope. They will not do if for weight loss. Funny huh!? But if a doctor writes it for another reason....I don't know what but I am told the doctor will know. The exact exclusion reads : surgical treatment and non-surgical treatment of obesity (including morbid obesity). I have heard of others that their doctors write it up as a hiatal(sp) hernia. Which is working in the same area. They paid the doctor 4,000.00 out of their own pocket for the rest of the surgery to be performed. I figure that isn't too bad compared to the 25,000.00 to 30,000.00. Well just thought I would pipe in my comments! Hope it sheds some light on the subject. Also am looking for a good doctor to perform surgery in the Miami area. Thanks for listening/reading. Karen Key Largo Pre-op 235/235/125