UHC

Im a City of OKC employee, and Im covered by UHC health Ins. There is an exclusion on policy for weight loss surgery. Ins will pay for everything leading up to surgery, but not the surgery itself. Its open enrollment at this time and I was thinking about switching over to BCBS but Im not able to afford all the deductibles. Can this exclusion with UHC be appealed? When I called UHC, a rep told me that surgery wasnt covered but it all depends on how doctor "words" it.....(didnt quite get that one)

Any suggestions on how to deal with this?

 

Thanks in Advance

As a rule when there is an exclusion there is no way to appeal it. Not sure what the rep meant and you would have to find out what they were talking about, unless there is something like a "must be medically neccessary". Usually tho when there is an exclusion that's it, none of the surgery is covered.

Now I'm just guessing here but I would bet if your employer doesn't cover it on one policy they aren't going to cover it on another policy either. It is your employer who decides what gets covered not the insurance company. So switching to a different insurer may not help. Is there an insurance rep for your employer you can discuss it with? Good luck!

Thanks for responding.
UHC is a HMO and will not cover it, but BCBS for Okc employees will cover it...no exclusion at all. I guess its that way since your basically paying for your own coverage. Its just so much for deductible. I just may have to switch.

Your dr needs to word this as a medical necessity not weight loss surgery.

I weighed 488 lbs and was refused by UHC for WLS.  I was told they had  total exclusion and I could NOT even appeal.  There was NO was it was NOT medically necessary.  The actual procedure is what is refused regardless of what the reason for the surgery is. 

I paid cash for my WLS and now 4 years later they cover it. 

ecdesperdue, it doesn't matter what your doctor says - IF the insurance has an exclusion, they have an exclusion.

 

Not true.  There are ins co's that exclude organ transplants and you can't get much more medically necessary than that.

Excluded means just that. WLS is an additional rider for the employer to pay.  If those premiums are not paid it is not covered.