Somebody please help me get approved.....sooner than later!!!!!

I have United Health Care HMO. I called and they told me that this type of surgery is an exclusion. And they told me that even if it's medically necessary they will not cover it! I know that I can't afford the surgery on my own. And I know that right now I can't even afford a lawyer to fight for me! Should I just give it up? Or is there still hope for me????? Thanks for your time and encouragement, you truly are angels!! God Bless!

First of all, NEVER TAKE ANYTHING ANYONE TELLS YOU ON THE PHONE AS THE TRUTH! Read the exclusions in your Summary Plan Description booklet. Is treatment for obesity listed under services not covered? If so, you will need a lawyer. If not, have your surgeon submit for a prior determination of benefits. You can always go to your employer, and ask for help from HR. Fight the good fight! Roberta

ok, UHC has two systems they use for thier policies. Both are set up differently. One is policy specific and one is more generic. Depending on the one your policy happens to be housed in, you will either get policy specific or very general answers. The more general computer system is set up to auto deny for all WLS procedures. You have to manually force the system to pay these procedures. It's not because UHC hates to pay for them, it's just that some policies don't cover it and if they didn't set it up to auto deny....all of them would be paid automatically. This way it forces a human to look at it for it to be paid. When you call the customer svs number and ask...'hey is this covered?' They look and see that it says no. Well, they aren't trained to know why, just that it's not covered. See where I'm going here? Unless YOUR policy says that it is excluded, then continue on. You were given a copy of your policy when you enrolled. If you no longer have this policy, contact your HR department. If there is an exclusion in your policy, that simply states that WLS is not covered. Period. No matter the ammount of fighting you do.....it still isn't a covered benefit. If there is no exclusion, according to UHC's philosophy, you really don't even need approval. UHC does not require referrals nor do they decide what is medically necessary. If your doc says you need it, and your policy covers it....you do it.