UHC says its covered,employer says its covered, y do i get an appeal denial:not covered

sweetestdyme
on 4/10/08 5:53 am - Memphis, TN

I switch to uhc in july of 06...i started calling that month to find out if it was coverd bcuz my insurance before had an exclusion...they said yeas i called a couple more times to make sure b4 i satarted the process....well i submit my letter at the time my bmi was 39 with acid reflux and urinary stress( really bad espescially in public). i also had my pysch and nutrionist eval and medical history...i was denied siting that i did not meet the requirements. The at the doctors office told me to come and weigh in again...this time my bmi is a 40.9 and im borderline for high chlesterol....but thats not put in my appeal just new bmi..so i get a denial this time siting that i am morbidly obese but i have an exclusion that does not cover the surgical treatment of obesity... i am shocked because i have been calling united health to make sure i was covered since july 06 to the very day i got the denial on my appel and they still say its covered even today...My employer says it covered and cant understand y it was denied it i am morbidly obese....i call united healthcare to let them know and they says say they need clarification from my employer becuz my policy says its covered if medically needed and there is also an exclusion in my policy.... so im now waiting on my employer to investigate... Is there not nothing else i can do since i have been told for so long that it is covered?

jtrandall
on 4/10/08 2:55 pm - TX
If you have not received it yet, get a copy of the insurance policy that covers weight loss surgery.  Unfortunately, you cannot rely on verbal discussion with you insurance company. Jim
bonnied
on 4/14/08 11:00 am - St. Albans, VT
Your employer needs to clarify this unfortunately.  I have ran into this with Cigna, and it took a few weeks to clear it up. Stay on top of your human resources person to get it resolved.
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