UHC/EPO exclusion

My employer switched me over to UHC EPO and assured me that if gastric bypass was medically necessary then the policy would cover it. I haven't seen a copy of the UHC policy yet but others I've seen online ti states that treatment of morbid obesity by medical or non-medical means is an exclusion. It does not however state anything about treatment of the co-morbidities. What am I missing here, has anyone else gone thru this. Any ideas would be greatly appreciated. Thanks, larimer_tom

Hey Tom...     I have UHC/EPO also and it's completely covered.Have you actually called and asked them, if there is an exclusion, it's usually due to the employer, not the insurance company...at least that is what I have read on this website. Hang in there and good luck in your journey!!!!

Thanks I needed to hear that, so far the only person who told me that it was covered was one of our corp HR people. When I reviewed my enrollment options back in Nov. it had a statement that it was excluded. When I lost me external appeal with Cigna I called HR and after some follow up I was told that they would switch me to UHC. I told them the reason I didn't initially do that was that there was an exclusion on the inforamtion I got in the mail. It was then that I was told that no it is included in the UHC policy but was being excluded on the Cigna policy, Thanks

Get a copy of your SPD or Summary Plan Description. It will say if its excluded. If it says it is covered, then it may have specific criteria that you have to meet. Some want documented attempts at weight loss for a few years. If it doesn't say anything about specific criteria, then usually, to meet 'medical policy' you usually have to have a BMI >40 and/or a BMI >35 w/2+ co-morbidities. Coverage for co-morbidities, like diabetic supplies or a blood pressure cuff, are a totally different thing. If you confirm that it is excluded for you, I would voice your concern with the person who told you otherwise. Good luck!