I will go anywhere in US for insurance approval.
Does your insurance policy have a exclusion for WLS or is it just a particular clinic that they are telling you they will not cover.
I would say to call your insurance company and ask them what
the specifics of your policy are regarding WLS and ask them to send
you a copy of the coverage in writing.
Carolyn, thank you, I am working on it. I finally got in touch with the agent that sold the policy to us. I did call the insurance and they could not find the exclusion but she knew they did not cover it. Duh... I will keep going until I get a clear answer and/or proof. If anyone out there sells Unicare or knows any loopholes e-mail me Please...Thanx, Brenda in Texas
Have you checked their website for answers or help?
Here is the link:
www.unicare.com
I found the following and copied/pasted from their website, but not knowing specifics of your policy, I can't really determine coverage.
You may can enter more information at the website and get more info, but here is the baisc---and I don't see an exclusion for WLS.
Medical Insurance Plan Limitations & Exclusions
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UNICARE Life and Health Insurance Company (UNICARE)
The primary limitations and exclusions for each of the plans described in this brochure are listed below. Please take a few moments to review this information. We want you to understand what your coverage doesn't include before you buy. These listings are an overview only. A comprehensive list of each plan's limitations and exclusions can be found in the plan-specific certificate of coverage booklet.
Limitations & Exclusions for the Performance 2000, 1500, 1000, and 600, Performance Plus No Deductible and UNICARE Saver 2000 Plans:
Services for any condition for which benefits are excluded by a waiver
Any amounts in excess of maximum amounts of covered expenses stated in this plan.
Services not specifically listed in the plan as covered services.
Services or supplies that are not medically necessary.
Services or supplies that are experimental or investigative.
Services received before the effective date of coverage or during an inpatient stay that began before that effective date.
Services received after coverage ends.
Services for which you have no legal obligation to pay or for which no charge would be made if you did not have a health plan or insurance coverage.
Any condition for which benefits are recovered or can be recovered, either by adjudication, settlement or otherwise, under any worker's compensation, employer's liability law or occupational disease law, even if you do not claim those benefits.
Any intentionally self-inflicted injury or illness.
Services received for any condition caused by or contributed by: (a) an act of war; (b) the inadvertent release of nuclear energy when government funds are available for treatment, (c) an insured person's participation in the military of any country, (d) an insured person's participation in an insurrection, rebellion, or riot, (e) an insured person's commission of, or attempt to commit a felony, or (f) an insured person age 19 or older being under the influence of illegal narcotics or non-prescribed controlled substances.
Any service for which payment may be obtained from any local, state or federal government agency except: (a) when payment under this plan is expressly required by federal or state law, or (b) services provided for the treatment of mental or nervous disorders by a tax-supported institution of the state of Texas.
Any services to the extent that you are entitled to receive Medicare benefits for those services. Any services for which payment may be obtained from any local, state or federal government agency (except Medicaid). Veterans Administration hospitals and military treatment facilities will be considered for payment according to current legislation.
Professional services received from or supplies purchased from an insured person, a person who lives in the insured person's home, a person who is related to the insured person by blood, marriage, or adoption, or the insured person's employer.
Services of a private duty nurse.
Inpatient room and board charges in connection with a hospital stay primarily for environmental change, physical therapy or treatment of chronic pain; custodial care or rest cures. Services provided by a rest home, a home for the aged, a nursing home or any similar facility service.
Inpatient room and board charges in connection with a hospital stay primarily for diagnostic tests which could have been performed safely on an outpatient basis.
Treatment of drug, alcohol, or other substance addiction or abuse.
Treatment of mental, emotional, or functional nervous disorders (including a smoking cessation program) or psychological testing, except as specifically stated in the plan.
Dental services.
Orthodontic services.
Dental implants or any associated procedures.
Hearing aids.
Routine hearing tests, except as provided under well baby, well child and newborn hearing benefits.
Optometric services, eye exercises including orthoptics, eyeglasses, contact lenses, routine eye exams and routine eye refractions.
An eye surgery solely for the purpose of correcting refractive defects.
Outpatient speech therapy, except as specifically provided in the plan.
Any drugs, medications, or other substances dispensed or administered in any outpatient setting, except as specifically stated in the plan. This includes, but is not limited to, items dispensed by a physician.
Cosmetic surgery or other services for beautification. This exclusion does not apply to medically necessary reconstructive surgery to restore a bodily function or to correct a deformity caused by injury or congenital defect of a newborn child, or to breast reconstruction performed to restore or achieve breast symmetry incident to a mastectomy and abnormal craniofacial structure caused by congenital defects.
Procedures or treatments to change characteristics of the body to those of the opposite sex.
Treatment of sexual dysfunction, impotence and/or inadequacy.
All services related to the evaluation or treatment of fertility and/or infertility, including reversal of sterilization.
Cryopreservation of sperm or eggs.
Orthopedic shoes (except when joined to braces) or shoe inserts, including orthotics.
Routine foot care.
Services primarily for weight reduction or treatment of obesity.
Routine physical exams or tests, including those required by employment or government authority, except as specifically stated under the plan.
Charges by a provider for telephone consultations. (Note: a Telemedicine Medical Service or Telehealth Service will not be excluded solely because the service is not provided through a face-to-face consultation).
Items which are furnished primarily for your personal comfort or convenience.
Educational services except for diabetes self-management training program, and as specifically provided or arranged by UNICARE.
Nutritional counseling or food supplements, except for formulas necessary for the treatment of phenylketonuria.
Any services received on or within twelve months after the effective date of coverage if they are related to a preexisting condition.
Foreign country provider charges, except as specified in the plan.
Services for which a third party may be liable or legally responsible to pay.
Growth hormone treatment.
Charges of a standby physician.
Charges for animal to human organ transplants.
All non-prescription contraceptive drugs, devices, and supplies and non-FDA approved prescription contraceptive drugs, devices, and supplies. Prescription contraceptive drugs or devices are covered under the Prescription Drug benefit of this plan.
Charges for pregnancy or maternity care, including normal delivery, elective abortions, cesarean sections.
All incidental supplies used by a provider in the administration of infusion therapy, except as specifically provided by the plan.
Additional Limitations & Exclusions for the UNICARE Saver 2000 Plan.
Any services of a physician, except as specifically stated under limited professional and other services.
Surgical procedures for sterilization (i.e., vasectomy, and/or tubal ligations).
Physical and/or occupational therapy/medicine, except when provided during an inpatient hospital confinement.
Acupuncture/acupressure.
Charges for any smoking cessation program or pharmaceutical related to smoking cessation.
Durable medical equipment.
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