United Healthcare is soooo short-sided!

Dear Members: I am a school teacher with the Miami-Dade County Public School System in Miami, FL. We have United Healthcare Point of Service. Our district is a fully funded plan instead of a self-insured plan. This means United is responsible for the payment of all claims not my employer. As of January 1st, United Healthcare has filed a certificate with the state of Florida to exclude any type of wt loss surgery for fully funded plans. This includes patients who have a doctor that states the surgery is medically necessary. This is purely a financial decision as we all know the surgery is expensive. I have been told outright by a United employee that this is the case. She has basically said that UHC almost never reverses a denial for patients who fall under fully funded plans. The worst part of all of this is that their denial of such claims is perfectly legal in the state of Florida! I have a surgery date, 1st denial and an appeal going. I doubt I will have resolution by my surgery date. I am totally disgusted and non-trusting of an insurance company who so blatantly disregarding my health and the health of other patients! There! I have said my peace! When United covers the surgery they are wonderful so I have heard! However, when they deny you they hang you out there to suffer!

Jennie, I am in the same situation in Dallas, Texas with United. It was Administaff's option to exclude coverage for any kind of Morbid Obesity treatment, but since we are a totally insure company United has the Last Say in appeals. I have already been denied twice, and have basically been told that there is not "Thing One, I can do about it." Administaff chose to put the exclusion in saying that it would not benefit enough employees, to incur the extra premiums. I say that it is just double talk for the surgery cost to much. They cover the gastric bypass surgery for 2 other girls in our office one in 2001 and one in 2002. If you find a loop hole to get United to approve it please let me know. Thanks,