Not Covered! UHC! Help!!!

Can somebody tell me what I need to do? I recently changed from Cigna to UHC (Jan 05) because they are supposedly easier to work with and I knew for sure they were going to be covering WLS-lap band. I have spoken to the insurance company several times since open enrollment and everyone I've spoken to has said "Yes! WLS is covered"....until today. I happened to call the ins co for something else and mentioned the fill for the lap band and the person told me then WLS for morbid obesity is NOT covered! I called several times after that, spoke with different people, called benefits through my husband's employer and was told the same thing by all. The man at benefits did tell me that is was possible that they could do an override but they have to talk to the benefits manager and said something about the fiduciary. What is that? and what are my chances of this happening. Has anybody ever heard of this happening? I had my hopes so high! I'll take any suggestions that anybody has to give me! Thanks!

Hi kathy, I know what you are talking about 100%! I also have UHC and I have been told many things also. Don't give up! Keep calling, talk to as many people as your can. Does your policy say anything about if it is medically needs that it will approve it? Surly there is something that you can do. I myself got denied the first time because the reason for the surgery was morbit obesity. But, they almost have to cover it if it is medically needed. Do you have any other problems? It is medically needed for me and that is what we are hitting them with now. I called UHC and talked to a very nice guy and he told me that if it was with a Doctor that was in Network and it was medically needed they would cover it 100%. Well, keep me updated and I will keep you updated as well. God bless you! Christina

Christina, Thanks for answering my post! I had a slight glimmer of hope on Friday. I talked with the insurance company and my policy says "Not Covered". It doesn't matter if it's medically necessary or not, but UHC said that they would contact my husband's employer's benefits group and try to get it overridden. I talked with benefits and they said that "IF" it's medically necessary then they would override it. Does medical necessity mean BMI >40? My BMI is exactly 40 so does that mean it's a "Yay". I'll keep y'all posted. By the way...if your policy is a non fiduciary then it doesn't matter what the case is, an employer cannot override at all. If there is a fiduciary then they can override it. Maybe this will help other people out. Kathy

Kathy, Good JOB! I think that you should really stay on the employer and get this thing going and done with. If you have to, call everyone at that company until you get a "yes!". I will be behind you all the way. I would love for us to write each other and help each other out with this whole thing. Please email me at [email protected] and lets fight this insurance thing together! Christina

Hello, i guess you all can add me to your bandwagon! I also have UHC and there is an exclusion in my husbands insurance. When i called they told me that it was covered "IF" medically needed. But a week later I called and they told me that it wasn't covered. I looked at my benifits online and it said that weight "programs" aren't covered in his policy even if they are medically nessesary. Well that is weight programs, This is weight surgery. So i called UHC up and they said that the surgery isn't covered either even if it is medically nessesary. So i am confused.... Do you all think i still have a chance? So guess i can join you all if you don't mind. Thanks, Ruthann

Hey Ruthann, Well...This sounds exactly like mine, Christina's and alot of other's situation! Don't give up! We will all fight this together! I contacted benefits/human resources dept to find out about the override. As long as it has the fiduciary they do have the right to override it. My email address is [email protected]. Y'all keep in touch with me and I'll do the same. Kathy

Ruthann, Welcome to our UHC circle of friends! Glad to have you aboard our bandwagon! Anyways girlfriend, Kathy and I know there is a way around this exclusion thing and we are going to get to the end of it! I call UHC almost everyday and they tell me something different everyday, trust me I know what you are talking about. When you call them, tell them you know that there is an exclusion, so it can save them the trouble. Get with Kathy and get her to give you the other number so you can get this thing on the road. There has to be a way for you to have this done. Do you have anything else wrong with you? Have you called your emplyer to override this thing? We can do this, with God we can do this! Hang in there girl! Be blessed, Christina

I go to my surgeon for the first time on Monday that is when my paper work will be turned into the insurance company. So we will see what happens. But if they deny me it is on, i will hire gary (obesity lawyer) or do whatever it takes to get this surgery... How would i go about asking for an override from his employer? How is your progress doing? Have you been denied? Thanks for being so nice to me. you and Kpaggett are so sweet.... We need to stick together. Love and take care! Ruthann