small group policy denial, HELP!!!

tweetiepie35
on 6/18/10 12:44 pm - St. Augustine, FL
I have a small group policy with United Healthcare in Florida and trying to get the RNY surgery.  Has anyone gotten approval through United while having a small group policy for this surgery?  They will NOT cover anything that is weight related, even with 4 letters of medical necessity.  Has anyone found another way around this?  On my appeal, I am going to TRY (and lots of praying) to get the surgery approved by using the PCOS, diabetes, sleep apnea and GERD as the reason I need the surgery.  The seminars I have attended stated that the PCOS (based on many studies) is resolved 100% and the others are resolved at 85% or better.  Any suggestions are greatly appreciated.

Thanks,
Angie
Redhaired
on 6/19/10 5:03 pm - Mouseville, FL
If bariatric surgery is excluded from the policy -- it is very doubtful you will get them to budge.  If the policy is self funded through your employer you could ask your employer to approve the surgery.  When the plan is self funded the insurance company is just an administrator.

  

 

 

lbs_b_gone
on 7/6/10 12:50 pm
I have United HealthCare in Florida for my primary insurance and it's excluded from the policy and they did not even care about it being medically necessary because of their exclusion clause.
Thanks,

Yolie
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