I was told it was covered, but it's not

I have worked in the medical industry for 15 years.  The one thing I know how to do is verify benefits and file appeals.  I've been to many seminars for my work and have heard time and time again that if you call to verify benefits and are told that something is covered, and the insurance comes back later and says it's not covered, then the insurance company has to honor what they told you the first time.  In my case, I verified WLS to be a covered benefit by UHC on three seperate occasions and have the call numbers UHC assigned to the calls.  When my surgeon submitted for prior auth, it was denied because of an exclusion.  I wrote an appeal, but was denied.  Very very frustrating.   If there is an exclusion, but you are told when benefits are verified that WLS is covered (three seperate times) can the Texas board of insurance make them pay?  Thanks in advance for your help!

Julie,  Did you get any responses? I am interested because this is what happened to me also.  Thanks,  Sue

Hey Sue, I received a response from a really nice guy about this.  Well, I emailed him because I saw where he was good with insurance.  If you'll give me your email address, I'll forward you what he said to me.  It made me feel better.  Just so ya know, there are several back and forth emails to the conversation. I wonder if we can sue UHC in a class action law suit for giving out false information to multiple patients.  You and I aren't the only ones they have done this to! Julie

Julie,  my e-mail is [email protected] or [email protected] either is ok.  thanks for your help Sue

The same thing happened to me, I was told on three separate occasions that the WLS was covered, and then, I was told there was a written exclusion to my policy and it was not.  I have UHC as well, and I hate them.  Would be interested in hearing more from you guys.  My email is [email protected].

Kristen, Did you appeal their decision?  I'm thinking we should all get together and sue them for false information and mental distress.  I'm serious!  I know that I had mental distress when I got my hopes up, went through all the testing only to find out they made a mistake  THREE TIMES in telling me it was covered.  UGH!  I'm so frustrated with them. Julie

Hi Julie,  Yes, I did appeal their decision, and I got back a denial letter stating that I was denied due to the written exclusion in my policy.

just to let you know you know have the right to appeal externally threw your employer if it is an employer exclusion. Don't give up that is exactly what they want you to do.

Wow!   And here I was thinking I was the only one this happened to!   I have Aetna PPO and was approved and actually went into surgery and had my belly cut open!   The surgeon didn't like the way my liver looked so he decided not to continue with the bypass, took some biopsies, closed me up and sent me to see a liver specialist.   After more tests, the liver specialist cleared me for the surgery, and strongly recommended it, so I went to a different surgeon who agreed to do the bypass.  When we submitted the paperwork asking for benefits to be transferred to the new surgeon ... it was denied because of an exclusion and they said the first approval was made by mistake!   Now I have a very sore, 5-inch scar to remind me of how close I came to having the surgery and now being told I won't happen!    I'd be VERY interested in what you've found out.    My e-mail address is:  [email protected] Debbi

Debbi, I hired an attorney to handle this for me and I received a emailed copy of the huge appeal letter from him yesterday.  I can email you a copy if you like. Julie