UHC let me down!!

Knowing I had an exclusion the insurnace company told me that it would be possible to get an approval with diabetes, high blood pressure, gurd, high cholestrol..... I know I have an exclusion, but they even denied the lap band claim with 35 bmi and co-morbidities. I don't know whether to appeal or not. I called and spoke with someone in the appeals department and they told me with the exclusion even though it is not a self insured policy I would be wasting my. WOULD I BE WASTING MY TIME???? I AM SO FRUSTRATED!!

If I were you I would appeal. It would be worth it to aleast try.  I am working on getting it approved for my husband and  I and we both have UHC.   It is fustrating I hear, ya. But don't give up!

It's really shameful that someone from the insurance company told you that. I know that if I heard one of my representatives tell a customer that at the insurance company where I work (I'm a supervisor), there would be some serious reprimanding going on! That's not acceptable to say and borders on illegal.

If you have an exclusion in your policy, you are going to have an uphill battle. But, there are always exceptions for everything. You always have the option of appealing or seeking legal assistance. Because you are under a fully-insured policy, please note that whoever offers you the benefits (typically, it's the employer) is the one who chose to exclude certain procedures under your policy. If you have benefits through your employer, you might want to try to talk with the benefits departments. If the employer okays an exception, the insurance company will follow suit. I know it can be done because I have seen it done before, but not without a lot of fighting.

I am sorry for the denial, and I truly wish you the best in getting this surgery for you, as I am sure it is important for you.