exclusion overturned??

Has anyone ever heard of a direct exclusion being overturned? My surgeon called UHC (United Health Care) to see if WLS was a covered benefit for me and was told it was. If they had been told no, we would not have submitted for approval. They submitted and 24 hours later recieved a phone call from UHC with a verbal approval and told my surgeon to schedule and that the official approval letter would be on the way shortly. My surgery was scheduled...but 2 days later UHC called the surgeon to revoke the approval. they stated it was a "mistake" and that it was an exclusion. They stated that the person the surgeon spoke with concerning approval is stationed in India and "sometimes they dont understand us too well" i had already made plans with my employer for time off...i had made MANY preparations..and now i look like a fool. Any advice? Will a laywer make them honor their original approval?

i think you should get a lawyer. maybe one that specializes in obestity surgery denial. there is a link on obesity help that will help you find a lawyer to help you. MAKE SURE YOU KEEP VERY DETAILED NOTES WHEN YOU TALK TO PEOPLE ABOUT YOUR CASE. DATE, TIME, EXTENSION, AND THE NAME OF THE PERSON, AND THE CONVERSATION TOO!!!! THIS WILL HELP YOUR PLY. good luck.

I agree GET A LAWYER and threaten to sue if you have to.

Andrea, I have been dealing with the exact same problem. I mean exactly. My policy book says it is covered with a BMI above 35, and I recieved a letter of approval. But when the Hospital call to verify coverages for the second time I was told it was an exclusion. Unfortunately there are disclaimer's in the policy book and the approval letter. Most Companies have a similar disclaimer as do most approval letters. I have decided to go self pay. I dont want to but I have heard fighting this battle is a long and expensive one. Most times more than the surgery itself. My co. is self funded and unfortunately my company makes the final decision. They also denied my appeal. They dont care if it is medically necessary or not. It seems as if it is the insurance companies fault, but at times it is not. Especially in my case. I wish you luck in this, if you get anywhere please let me know because I have the same exact problem, and it just so happens to be the same ins co.

Have you tried speaking with the benefits manager at your place of employment? They sometimes have the ability to sway or overturn the decision of the insurance company, since they are the ones who selected this as your coverage. If you haven't tried this already, I would do so. Let them know you were told it was approved and that they then changed their position. Maybe if your employer threatens them to make it right it will have more impact than if it came from you. If that doesn't work ---- call an attorney! I wish you the best of luck Nancy