UHC, self pay, or fight??

crgeorge
on 10/5/09 3:46 am
OK, so, I recently found out due to abuddingrose's research that Georgia was the first state to enact a law stating that insurance coverage for wls is mandatory (at least, that's the way I'm reading it...).  We have United Healthcare Choice Plus, and they say they do not cover it due to my husband's company excluding it specifically.  What I want to know is, how do I go about changing this?  Do I contact UHC, husband's office, a lawyer?  I'm just not sure where to start.  I can't do self-pay because I have horrific credit and no co-signer.  Diabetes, arthritis, sleep apnea, and probably high cholesterol are all a major issue for me... I really need this and I can't seem to get anywhere close.  At the very least, does anyone know of any financing available for people who have severely damaged credit??

Catherine
(deactivated member)
on 10/6/09 1:50 am - LOUISVILLE, KY
Sounds like your in the same boat as me. My husbands ins. also excludes it. My husband has a union so I would have to appeal to the union, since its the employer not covering it. Whatever company he works you will have to find out if they have a union or hr or someone whos head over the company and find out why their not covering it. You may have to contact the ins. company and they may be able to tell you.I myself do not want to self pay I have bad credit as well, and I did have a co-signer but their against the surgery so thats out.Anyway I would fight it, if you want it bad enough do some research, go to obesitylaw.com they may help you too. Hope it works out for you.
crgeorge
on 10/6/09 3:24 am
Obesitylaw.com, great resource!  I just contacted them to see what can be done.  I want to make sure I'm reading the Georgia law correctly.  They should be able to tell me what I need to do, or if this is something they can fight for me.  Thanks for the tip!!
akindofmagick
on 10/6/09 9:02 am - MD

I filled out the form and wrote obesityhealthlaw.com twice asking if they could give me any advice regarding my company's WL exclusion, United Healthcare, and the weight loss laws in the state our policy is written (VA) and the state where I live/work (MD)....  and they never answered.

I was very excited when I read the text of the excellent WL law in Virginia... until I learned (according to United Healthcare) that the law only says the insurance company has to OFFER weight loss surgery options. 

My company has a written exclusion in their policy for ALL weight loss programs, so I'm outta luck, unless the company grants a waiver to the exclusion.

You might want to contact your state attorney general's office for additional info.

I decided I wanted to keep my job...

Sheri

I've been fat, and I've been thin - and thin is better.  

There is a better way. --Alaine of Lyndar 
--------------------------
HW: 234. SW: 228 (18 June 2015). GW: 137. Specs: 50ish, 5'4"

Dainty10550
on 10/6/09 9:22 am

I was recently approved for gastric bypass under United Healthcare Choice plus, but the weight loss was written into my companies contract.I beileve for UHC to cover the procedure it has to written into the contract.

crgeorge
on 10/7/09 1:48 am
Well, if I don't hear from them in a couple of days I'm going to call them.  The squeaky wheel gets the grease, right?  I used to work at the same company my husband does.  They are a strangely uber-healthy company... almost everyone who works there is super thin, they have strictly health food in the cafeteria, and they have a fitness center.  Most of the people there run in the company marathons and/or ride their bikes in the company bikeathons.  I think they have excluded anything regarding weight loss (they won't even cover doctor supervised weight loss plans!) because they think it is unnecessary.  I feel like it's discrimination but I guess we'll see. 
poet_kelly
on 10/6/09 9:40 am - OH
You need to contact your husband's employer.  Georgia law requires that health insurance companies offer coverage for WLS.  However, the law does not require that employers purchase that coverage.  Your husband's employer elected not to purchase coverage for WLS, and legally they are allowed to decide not to include that coverage in their health insurance plan that they offer employees.  Your husband's employer would have to change their policy.

Kelly
crgeorge
on 10/7/09 2:17 am
I am guessing it is difficult to force a company to change their policy.  Has anyone managed to do it?
poet_kelly
on 10/7/09 1:37 pm - OH
I'm guessing it is difficult.  But you can always talk to them about it.

Kelly
abuddingrose
on 10/10/09 4:43 am - Essex, MD
I haven't bbeen here for a while.  I have found out that UHC is ultimatly goverened by the US Department of Labor and have recieved a response from them.  There is nothing any one can do to force UHC to pay for the wls.
I also contacted Obesity law and was told they do not enter into litigation and could not help me.  What I have done is filed my last appeal with addtional information, in cluding a cost comaprison  of the cost of the surgery and what they have spent on me medically this year 25,000 vs 38,000.  I also gave them permission to share all of my information with who ever they had to in order to get what I need.  It has been almost three weeks since I sent it and the other denials took about 10 days to come back.
So we will see what happens.  Good luck to every one
never settle for less than you deserve and you deserve only the best.                            
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