PLS HELP UNAPPEALABLE EXCLUSION Even if Medically Necessary

I JUST CAN'T BELIEVE IT! My Insurance has an exclusion. A BIG NASTY UN-APPEALABLE exclusion. I have talked to 4 different people now at the insurance company and the underwritters who sold our company the policy, and I can't believe that my perticular policy with UNITED HEALTH CARE PPO has a complete - even if medically necessary - exclusion. I'm not going to back in time and tell you blow by blow how originally I was told by UHC that this is covered, or that when I received the denial letter, that UHC told me I could appeal - so I remained ever hopeful. Now I'm just devestated.... What are my other options??? I could probably borrow from my 401K plan and I have decent credit to get a loan - Should I consider Mexico or some other country??? It feels like I'm starting all over again... How do I start this ball rolling? Geeez how much does the Lap Band procedure cost? Suggestions??? What did you do??? You all have alway been so wonderful - so supportative. Thank you in advance for sharing with me.

I received my policy in a PDF file of 130 pages plus. These are the two area's for which they are drawing their conclusion. J- Physical Appearance 1. Cosmetic Procedures. See the definition in (Section 10; Glossary of Defined Terms.) Examples include: A. Weight loss programs whether or not they are under medical supervision. Weight loss programs for medical reasons are also excluded. Q. All Other Exclusions 9. Surgical and non-surgical treatment of obesity, including morbid obesity. We Do not Pay Benefits for Exclusions We will not pay Benefits for any of the services, treatments, items or supplies described in this section, even if either of the following are true: ? It is recommended or prescribed by a Physician. ? It is the only available treatment for your condition. The services, treatments, items or supplies listed in this section are not Covered Health Services, except as may be specifically provided for in (Section 1: Covered Health Services) or through a Rider to the Policy. If this is the case, any Exclusion of such a service, treatment, item or supply shown in this section does not apply. So then I called, and wanted them to explain this, how a "Medically Necessary" procedure could be excluded. - It is not experimental nor cosmetic. They all just referred to these sections and basically said that it would not be approved regardless of what I submitted. I thought about contacting an WLS attorney to see if anything could be done, but I'm a bit leary with wording like this and was hoping someone out there has been through something like this and maybe even overturned it and won Thanks

Email [email protected] and see what he says. Mine was excluded too but each state has differeing rules etc. M

I have the same exact plan. I fought on my own for 9 months, I hired Gary V, and still lost, save your time, frustration and money, IBA doesn't give a rats a$$ about anything but, IBA. Elise

Hi Elise, Thanks for the responce. I did give up. My last chance was to go with Gary, so I emailed him w/ a copy of the exclusion listed in my policy, and he was kind enough to spare me the fee, and told me he that Florida is alllowing these type of "Even if your life depended on it" exclusions. I would most likely not win and to seek other alternatives. Once I was denied, Dr. Jawad's office quit speaking to me. They wouldn't even email me back about being a self-pay and finance options. So I bascially has to start from square one. I found out about Dr. Ortiz in Mexico, His reputation is incrediable, his price is much better than in the states, and I emailed about a dozen of his previous patients. So long story short, I did a 401K loan, and schedule the Procedure with him in Mexico. I'll be flying over there on Monday the 10th and having Surgery on the 11th. In saying that I hope you find a way, whether it be a 401K loan or someother type of loan or service to help. Aside from the Medical Loans I have also heard about a place called Vocational Rehabiltation. I hear they help pay for the surgery so people can get a job or keep it. I didn't qualify for their service, since I'm not unemployed and have been with the company I'm with for many years. I wish you the very best. Lehigh Barbie

I'm glad you found the doctor in Mexico. Do you have any website or other information on him (online) you could share? I live in Arizona and BCBS has a super-exclusion in my PPO plan for the surgery. OBlaw really can't help me on this one they said and told me to "save your $500". At least they were honest. ErikMesa