Need help with UHC PPO and IL insurance

I am so upset I don't know what to do. I called the insurance and they say that weight loss surgery is excluded entirely on my policy...what do I do? I am 325 pounds with severe lower back problems, severe sleep apnea, borderline diabetic, and other misc problems. Can anyone help me?

Your employer is the one who excluded it, not UHC.

How can my employer include it? Do I have to wait until they renew to include it? Does it cost the company more to include it?

Very easily.  Your employer has to pay more if they want to include it.  If you work for a large company, you can posssibly talk to your human resources people.  You also need to look at your policy (again, a trip to your human resource dept) to see the wording of the exclusion.  Sometimes you can fight it based on the wording...i.e. they may exclude surgery for obesity, but morbid obesity is completely different.  Until Dec 31st of last year, my employer (the State) excluded it from all policies.  Fortunately, they came to their senses and added in for the new year to some of their plans.  Their exclusion stated it was excluded for treatment of obesity INCLUDING morbid obesity.  Anyway, it all has to do with the language of the contract.  There is an attorney who can possibly help you fight an exclusion (Walter & Kelly Lindstrom out of California) and they are honest.  If they see the language of your exclusion and don't believe they can fight, they won't take your money.  But in order for them to help, you have to go thru the whole process and get your denial...

Good luck.

So what you saying is "Sometimes you can fight it based on the wording...i.e. they may exclude surgery for obesity, but morbid obesity is completely different.  Until Dec 31st of last year, my employer (the State) excluded it from all policies. " Means that if a person is morbidly obese and if those words are not listed specifically in the exclusions that there may be a good chance for approval?  I have the same health insurance she has and treatment for obesity is excluded but nothing is said about morbid obesity.  I am glad I read your post.

Yes, you MIGHT (and I emphasize the word "might") have a chance.  The medical coding number for obesity is different than for morbid obesity.  I would anticipate a fight on your hands though.  You would have to go thru the process and submit to insurance.  You'll probably get a denial.  Then, you can fight.  And you STILL might lose.  I think you have a better chance if you have some co-morbidities as well.

The other thing to think about is who is your employer?  Is your plan self-funded?  If you have a large employer, you might have a self-funded.  I think those can be harder to fight.

I'm not saying it will be easy, but if you don't fight, nothing will be changed.  I fought...and the State of GA added it to their plans.  Was I the sole catalyst?  Probably not, but I'm sure my efforts pushed things ahead.  It took what seems like a long time, but I got my approval Tuesday and my potential (hasn't officially been scheduled yet) surgery date is May 6th.

Good luck!

thank you for the well wishes and i am prepared to fight to get what i need.  I have found out that my health insurance is not self funded.  As for co morbidities  they do exist.  Hi blood pressure, hi cholesterol, anxiety disorder, and sever osteoarthritis.  I am going through the preliminaries for the wls right now and am almost finished.  I stand 5 feet and 5 1/2 inches tall weigh in at 269 with a BMI of 45 and as a result of two botched surgeries on my right knee can not enjoy life very much.  I can not stand , walk , ride a horse, ride a motorcycle, enjoy social or professional gatherings with out haveing to set down and away from the crowd.    I have seen a orthopedeist for my knee to get a total knee replacement and he says that if I have the wls that i may be able to delay the total knee replacement for 10 yrs or more.  I also have a letter of support stating such.  So we will see what happens. 

Sounds like you might have a chance!  Have you already established yourself with a bariatric surgeon?  When I first submitted for pre-authorization, the surgeon's office wouldn't submit it since they knew that my insurance wasn't going to pay.  I had to collect everything and send it in myself with a very well worded (if I do say so myself) 4 page letter on why I needed the surgery.  I also sent letters of support from all my specialists in support of the surgery.  If you haven't gotten letters from all your docs, that might be a good idea.

After you submit, if you get a denial, there are a few people on OH who very generously give of their time to help people write appeal letters.  One nice lady that comes to mind is "Vicki".  She posts on the insurance board often.  Or you can send the "bulldogs" and contact Walter and Kelley Lindstrom at obesitylaw.com.  They are WONDERFUL!  I couldn't possibly say enough nice things about Kelley.  Their fees are VERY reasonable and they are honest!  Strange for an attorney, I know.  And while they will never tell you not to fight for surgery, if they don't think they can help you, they will tell you upfront and not take your money.

GOOD LUCK!

I agree, it is the employer.. I have UHC PPO-Choice Plus. What  you can do is check your UHC, and go under benefits and coverage and then look under extra plans and then for centers of excellence.. They actually have University of Chicago under Bariatric treatment for in network. They were to far for me to get to my appointments, so I just decided to go to Central Dupage Bariatrics. The case manager said that they dont have as much problem with the HMO's as they do with the PPO's.

How did you make out ?  I have the same insurance and followed your advice and found a local hospital and many doctors that are listed.  Please keep us updated to your progress.   I am almost finished with my preliminary workups.