Gary- Untited Health Care exclusion

Hi Gary.  I have an exclusion on my UHC Choice Plus policy. It says ," Surgical and Non surgical treatments for obesity."  Would Morbid obesity be considered under this catagory? I know obesity and Morbid obesity are different.  Any feedback is greatly appreciated. Many Thanks 

I can answer that yes morbid or obesity is the same your policy totally excludes weight loss programs whether surgical or non surgical

Hello Vicki,

Is it worth fighting an exclusion?

Thanks, Maria

Maria you need to find out if your United Healthcare I assume is through your employer or spouses employer.   You need to find out from the Human Resources department at the employer if this policy is a fully insured or self insured policy.   You might have a better chance with fighting it if the policy is self insured policy were if you appeal to your employer to overide the exclusion and they have the insurance make an acception

Hi Vicki, I have Anthem BCS through my employer in Connecticut.  My employer did not pick up the rider.  Policy is I guess fully insured but my employer will pay for hospital deductibles and deduct. for MRI and the like.  I am very ambivilant as to hire Atty Viscio and fight this exclusion.  I would have to borrow the money to hire him.  Is it worth doing, don't know!  Very risky investment. 

Thanks for your time and info.

Maria

WHen a policy is fully insured and have an exclusion its harder to fight and you would probably need to talk to Gary,  I dont know if they take on exclusion problems cause I know obesitylaw.com does not  see their criteria

http://www.obesitylaw.com/assist.php

if a policy is self insured a employee can file an appeal with the employer to make an exception and have the insurance approve but if its fully insured policy an employee doesnt have that option

Vicki thank you so much for answering all my questions.  You've been a huge help.  By criteria do you mean the policy itself?

Gary did say he could help me but I'm very skeptical and don't want to waste my money that I need to borrow in the first place.  I did get some feedback from former clients of his and it was all positive.  However, none of them had an exclusion. 

Thank you again,

Maria

Yes criteria I do mean the policy.   As far as Gary and that decision that is something you would have to think and make the decision as no one knows someone elses finances

Thanks again for all your help Vicki.

Maria

Vicki,

Do you know what CPT code that Tricare will approve for the vertical sleeve gastrectomy (only, no duodeneal switch)?

It states on their web site that it is covered, then they say code 43843 (surgeons office submitted) isn't covered.  I don't have access to codes so need some help. The last CS person I spoke too said the procedure is covered but wrong code, to call back with different codes and he will tell me if allowed or not.  I appreciate any help you can give me.  Thanks