Two Insurance Plans - Both with issues...Looking for HELP

Geminii37
on 12/13/07 5:00 am - Carthage, MO
HELLO!! My name is Michelle and I really could use the expertise of many of you on this site.  I have looked through many pages of posts and do not see what I am looking for, so here goes... I have two policies...My husbands policy which is employer funded and is requiring a 3 year mandatory time on the plan before it would be covered...which right now I would have a year ond a half to go....Then I have insurance with AT&T through United Healthcare which on that plan it is "not covered" per the lady at UHC. My question or problem is this~I cannot wait the year and a half health wise.  I am 6' tall, BMI is 55 with MANY co morbidities and at 37 I don't want my health to decline anymore which it certainly will by 2009.   So, is there a way to get around either situation??  Either by fighting the company funded policy or UHC which is stating "Not Covered"??  I was told that it actually might be easier to fight UHC than the company funded plan, and that there is attorney's who I could hire for a flat rate to do so.  Any would be greatly appreciated. Thanks so Much ~ Michelle (Missouri) 
Xavier Smith
on 12/16/07 3:54 pm - CA

It looks as if you have coordinated benefits, which is the same as being covered by two separate insurance policies. Because your employer is AT&T, UnitedHealthcare will be your primary insurer followed up by your husband's self-insured plan.  If bariatric surgery is not covered under your primary plan, you can submit that information to your secondary insurer for coverage.  Of course, coverage under your secondary insurer will be based on your plan's limitation.  If the insurer requires a three-year waiting period before considering bariatric surgery, then it is typically a hard and fast rule that most likely cannot be changed--at least not without some type of legal intervention.  It's much easier to fight with "regular" insurance plans than with self-funded ones. From the information you have presented, your options by yourself seem limited.  If you feel the situation is exigent, then you might want to consider speaking with an attorney about your options going forward. I wish you the best you in your endeavors.

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