Written Exclusions

Has anyone gotten around a written exclusion in their policy? and on average how long has the appeal process taken? I have United Healthcare, and my employer has an exclusion for any treatment related to weightloss, obesity and morbid obesity. I am thinking of purchasing a conversion policy that only says does not cover weightloss or obesity treatments...but I don't want to spend all of that money on my own if I can't get a succcessful appeal. I can get insurance from Nationwide INS. but I have heard that they never cover the surgery, even in appeals. I have to decide really fast. My current policy ends at the end of august. Any help or words of wisdom would be great. Should I look into getting a lawyer? will that increase the speed and success of the appeal process? Melissa

What State do you live in? Many States mandate that they cover the surgery even if its excluded. Gary Viscio www.obesitylawyers.com

Melissa, I too have UHC (employer self funded). My policy has a written exclusion with many contradictions. I am currently on my second appeal. No reason offered for the exclusion. I am going to take this battle as far as I can. You should check your benefits book to see what your appeal process is, and if it will go to a peer review. Most of these policies are goverened under ERISA. If this is the case on your policy you may have a chance to overturn the appeal.

I also work for a company that is self funded with United Health Care. Our policy also has an exclusion against the surgery. I have been trying to get my employer to remove the exclusion. We will have open enrollment at the end of the year. However, another person that I work with had the Lap Band and UHC covered everything. She was expecting a denial and then her husband's insurance would cover everything, but our insurance covered it. I am trying to do the same. If I don't get approved, I can wait until February (one year from her date of service) and go to my employer and request that they cover it since they did for her. Also, I am hoping that with the change with Medicare, that they will remove the exclusion. Try asking your employer to make an exception for you. You never know! Terry

What ever happened to your case? Did UCH ever cover it? Did you get a conversion policy? In the same boat as you, so just wondering. Thanks Phyllis