Exclusions and fighting

My UHC Choice Plus Ohio policy has an exclusion. According to UHC (if you talk to them on the phone), none of their policies DON'T have an exclusion for WLS. So I'm assuming that lots of people have this exclusion in their policy. However, I've seen many many people get approved even the first time they submit. Anyone who had an exclusion in their policy (any company, not just UHC) care to share if they had to fight or if they got approved right away in spite of the exclusion in their policy? I have just read so many scenarios, I dont know if I'm in for a legal fight for sure or if I might get approved in spite of having an exclusion. Thanks for this board and everyone's sharing their experiences. rs

Hi R S, I also have UHC and my job as well has an exclusion that says they will not pay for the surgery...I have called them and all they say is it is not covered because my company did not want it included. I really need this surgery but don't know what else to do...please let me know if you hear of anything we can do...my email address is: [email protected] Thanks and good luck... Barb

I also have the same exclusion only with Humana. I actually wrote a letter to my HR department to see if they would cover me because i work for a large bank. I thought i was getting somewhere when they called me back but they just said they would forward it to Benifits and i havent heard anything else that was almost two weeks ago. Try to send it to your employer though, let them know how valuable you are and how you want to be around to work there but your health is in jeapordy. Keep me posted. Both of you.

I have an exclusion with Healthsmart here in Lubbock. Not sure what will happen. Curious if anyone has eventually been approved even with an exclusion.. by the way, I'm new.. my name is Jeri

Okay guys we have to come up with a plan. We are all in the same situation even though different insurance companies. What are we to do? Like i said i sent the info to my employer and waiting to here back. Lets get fired up about this!!!!! We have to come up with a game plan.

I agree but I don't want to die waiting. Instead I may just go out of the country and self pay and THEN sue. What about a class action suit? Geez I am not a litigious person so saying that surprises me.

I have actually thought about the same thing and I'm a Registered Nurse of 10 years. Medical tourism they call it. Needs more investigating I think but they say the medicine and care are just as good as the US. They don't worry about law-suits as much because medicince is respected, the MD's are paid, and they care about their reputations to the point that they make sure theire medicine and care are just as good. They're talking..(blah,blah,blah) about eventually restricting this... but anyway, you have to do what you have to do. Read the article at the bottom. It's interesting. I'm tired of trying to come up with scenarios to get this covered. Looking for new insurance which you can't get because of your ht and wt. My husband is starting a new business and so looking at small group health insurance with my husband and I have separate policies and so counting for 2 employees. But my brain almost can't take anymore. I feel like I'm "scheming". Even the small group policies have some sort of wt treatment exclusion, but I guess these general exclusions are one's which can be covered if medically necessary... I don't know? I'm insurance illiterate! http://www.newstarget.com/007097.html

You know what I don't understand? Alcoholics and drug addicts are usually covered for some kind of treatment but us fat folk, well it must be our own fault for being this way... why don't we just stop eating? Yeah, that would fix it.. right? Someone can go out there and stick needles in their arm and get their treatment paid for but not us, no... we're this way because we want to be.. but not a drug addict, it's not their fault they are addicted to drugs, right? grrrrr!!!! I'm sorry.. I just had to vent. It makes me so mad how we are discriminated against and made to jump through hoops.

I know exactly what you mean. You would think the insurance companies would see that treating a surgery, let's say $20-30,000 which could help resolve or prevent hypertension, diabetes, arthritis due to wt, heart attacks, etc. and decrease the long term cost of treating these diseases. Then again, this i called preventative medicine and most ins. and MD's don't believe in this. I guess it would interfere with too many jobs! What would they have to do or insure then!!!!

Ok...I just got word today that my first attempt was denied and after reading everything there is on this site about my chances of getting my UHC exclusion overturned, I've decided I'm not likely to win and I dont want to take the time needed and then lose anyway.... So, today I met with an agent who has Anthem Blue Access which is supposed to be a good company for WLS. I can sign my husband up with this new plan but I am worried about something... When we sign on to the Anthem plan, the agent said we need to provide amoung other things, a copy of our current insurance bill. I've recently completed all the preliminary testing...psyc, nutricianist, PCP, slee test...for getting approved. Wont Anthem suspect that I am up to something and planning for a big surgery and possible turn down our applications? RS