UHC

Has anyone ever been approved when they have an exclusion in their policy that states : "Surgical and nonsurgical treatments of obesity (morbid Obesity) are excluded"

Hi Thinking about WLS, huh? Me. too. I have UHC and that exclusion. I have an appointment w/ a Bariatric Surgeon next week and I going to see how it goes, his secgratery (can't spell) said there shouldn't be a problem if it's medically nessesery. I have my fingers crossed. The Surgeon is also under my plan. Tina A

Hi Tina, I have an appointment with the surgeon too next week. Thursday @ 9am. I have done everything else. Dietician, Psych eval, PCP, everything. I turned all paper work into the surgeon yesterday and I go for the consultation like I said next week. Than they submit everything to insurance. I am so nervous. Ingrid

Does it actually have the (morbid obesity) in it?? Mine says "Surgical and nonsurgical treatments of obesity are excluded, then goes on to say that it covers morbid obesity. If yours is like you put, but with no pararenthesis, then you might get them to pay anyway. Just keep appealing, and asking why turned down, and give them reasons that they should pay.......... like the costs of comorbidities. Even if you are not diabetic, but a parent, sibling, or relatives are........ put in that they are and that you a candidate for diabeties, it contributes to many other diseases that they would rather not have to cover, but will have to if you should become diabetic. Good luck. My insurance covers the surgery and wanted me to do it OUTPATIENT! Then when I told them that they have to check for leaks the next day or so, they approved ONE day!! Really generous of BCBS!!

I'm trying to fight the exclusion also. But mine was put on by my employer so I'm having to go thru them to get it approved or over turned. I called UHC and they told me that if it was excluded there wasn't anything they could do. It would have to come from my employer giving them permission to cover it. A friend at work is also wanting to have the surgery and she and I had planned on having it this year. Then we found out they excluded it. I'm submitting a letter about my situciation as well as letters from other people at my work that did have the surgery and how it has changed their life and health. I'm keeping my fingers crossed they approve my appeal. Mine even said it didn't matter if it was medically necessary or that it was the ONLY treatment. Good luck! Jennifer

You are right. Employer exclusions have to be removed or waived for you by them. Since it is them, be sure to relate how surgeries improve health, and that reduces absentee-ism. (If you have not be absent much, and they say that, tell them -- as you health deteriorates more days absent are inevitable.

Hey guys!! I too have one of those dirty little exclusions in my policy. I also have UHC and my exclusion states: Surgical and non-surgical treatments for obesity even if medically nessesary (including morbid obesity). I when to my consult with my surgeon and I knew I was going to get denied, but that is what I wanted, So the doc sent in my paper work to UHC and 2 days later they denied me because of a "direct exclusion". So I got all the letters I needed made a list of my meds and hired Gary Viscoe (obesitylawyer.com) to help me and that is what my status is currently, I am going to fight them , I knew they would deny me, but that wasn't going to discourage me, I had a plan before they ever denied me. So now I just have to wait, but It will be SO worth it in the end. No I will just set and swiddle my thumbs..... Ruthann J.