UHC exclusion policy..

My UHC benefits book has the exclusion policy "surgical and non-surgical treatment for obesity, including morbid obesity" I was wondering if there is no way around it?...my doc said he would try his hardest (and considering my mommy works as his nurse i believe him) what do you guys think? Love, -Vero

My policy from UHC says the same thing. I was just denied on my first appeal this week. I received a letter from them saying that I can now appeal it to a review board. Im going to fight this as far as I can. Good luck with yours.

I have called my insurance company (UHC) twice enquiring about WLS. The first time the guy started out saying that yes it was covered, then suddenly changed his mind and said no, it wasn't. I asked him "what about for medical reasons" and he said my dr would have to send in a predetermination letter? I called again today and asked another person if I had any "exclusions" on my policy and he said no. Then I asked if WLS is covered under my policy and he said "No". I asked him what about medical conditions, and he said it still would not cover it. I am in the process of waiting on a call back for my consultation with my dr. I am told that most of the bariatric surgeons pretty well already know which insurance companies will pay and what their requirements are. I wish I could hurry up and find out, this is really worrying me. I have also heard in some states, insurance cannot deny WLS if it is a medical necessity. I wonder if Alabama is one of those states, does anyone know? Thanks for any help or encouragement you can give me. Kelly UHC is the

Veronica, First off you need to find out if the UHC you have is company self funded. Self funded insurance do not have the same appeal process under ERISA they can say "No" and it does not have to go before a review panel, that is the bad news, now the good news is, that if you are not self funded, an exclusion can be easily overturned in the appeal process under medical necessity. Good luck, Viola

Thanks so much for all that info...I had my appointment today with my pcp and he is sending in my request for wls tomorrow (at least his part is guaranteed since my mom is his nurse) and he is going to help me push this thing all the way..you guys please wish me luck cuz ive heard some real horror stories.....my doc told me straight off the bat that the ins. would probably deny me the first time but then with an appeal we should get in on the second or third try...I just hope this all pans out!! Love, Vero

That's a pretty clear exclusion. However, if your employer is self insured, they can choose to pay for the surgery for you if they want. Do you have co-morbidities? Appeal showing how the surgery would resolve the co-mobidities. Do a business case analysis to show how WLS would be cheaper for them to pay for then managing all of your co-morbidities. Fight the good fight! Roberta

Mine too. What happened? Did you appeal, did they overturn your denial?? Thanks. Phyllis