UNITED HEALTHCARE PULLS A FAST ONE!

I contacted our company insurance carrier United Healthcare two months ago to ask if they covered morbid obesity surgury and was told that they did. Our policy renewed July 1, 2003 and they have now excluded all treatment of obesity INCLUDING morbid obesity. The policy type is the United Healthcare Options PPO. I'm sure that if United Healthcare gets by with this, other carriers will follow suit.

If you started the process and started getting all your doctors appointments before it changed, you may still have a chance...

Donna, I had the same thing happen and according to my HR person and the medline of UHC, although the surgery has an ironclad written exclusion now, they do offer a rider policy for companies to pick up supposedly(my company is small but I know another company that has UHC that covers the surgery). When I discussed the possibility of my company getting this I was met by a barrage of cost limiting factors. I felt it was somewhat discriminatory in practice as I am not asked if I want to pay for pregnancies, drug/alcohol treatment, etc; yet our contributions pay for these. I also approached my insurance commission with the argument that by UHC creating a rider policy for specific conditions, were they not in fact making a discriminatory determination against people who were obese/morbidly obese. Of course, my local bureaucrats told me that there was no legal basis for my claim. I have read a lot of posts regarding appeals. I examined the appeal procedure thoroughly (I tend to be geeky like that) and spoke with several representatives. What I found in fine print appears to be the fact that although UHC cannot deny you an appeal and will allow you to use a third party medical review that the determination must be compared to the statement of the policy. According to what an attorney friend of the family stated, this means that even if the nmedical review says that this surgery is warranted and needed that is applied with consideration to what the policy states and in my case is a direct exclusion, therefore would be denied. I didn;t understand the purpose of an appeal that only allows someone to concur need if the policy is the ultimate mandate. Again, my local insurance commission indicates that this is not violative. I think that if you began the "process" prior to the change that you may stand a chance to argue the point against the modification, especially if your PCP submitted any documentation for consideration. I wish ya the best of luck, I am in the process of looking at a tens of thousands of dollar paycut simply to get insurance that will cover this surgery. My fear is that something similar may happen when I do. Take care and don't let them off the hook!