My insurance denied, but there is exclusion... What should I do next?

My insurance is United Healthcare Choice Plus, I have in and out of network benefits. I have studied the policy carefully and it clearly states that tx or surgery for Morbid obesity is not a covered benefit, but there is an exclusion if deemed medically necessary. My denial letter I recvd. from UHC, stated that "even if it may be medically necessary, my policy does not include benefits for this proceedure."(why would the policy say it will cover care if deemed medically necessary in or out of network if they are saying there are no benefits?). My PCP has signed a letter that I wrote with all my diagnosis and medication I am on and diet pills and diets that I have tried etc. He signed it and said he agreed with everything that I had written and agreed that this surgery would be beneficial for me. The question I have, is what now? what else can I do??? What do I do if they deny it a second time? I know that United Healthcare is one of the better insurances that New Start works with, so I feel like there is still hope...plus I have been praying if it is His Will, then it shall be done. I just want to be sure there is nothing else I can do to help things along. Thanks.

We greatly appreciate your interest in helping us build our Q&A database. To discourage vandals from posting garbage, however, we require people to register before posting.

You must be logged in to post an answer. Click here to log in.