Question:
How do I handle conflicting info from insurance & exclusion?

My insurance is United HealthCare, Choice. When I initially contacted my insurance company and asked if weight loss surgery was covered under my plan, I was told that there was coverage for morbid obesity. I was recently denied because of an exclusion in my policy which states: "Health Services and associated expenses for the surgical treatment and non-surgical medical treatment of obesity are excluded." The wording in this exclusion does not say anything about morbid obesity. I called the insurance company again after I was denied and some of the reps. are still telling me that my plan will only cover morbid obesity, but not obesity. I was told to appeal, but I am not sure what to say in the appeal letter. I have my Certificate of Coverage, but it doesn't say anything about morbid obesity in the book, and I haven't been able to get anyone from the insurance company to give me anything in writing that states that morbid obesity is covered. Could you give me some advice?    — angie305 (posted on July 30, 2003)

July 30, 2003
Appeal it. There are appeal letters in the library of this website and on the "journey" page. Also ask your Dr to resubmit and make sure the diagnosis and diagnosis code is for "Morbid Obesity" NOT "Obesity". From your denial it sounds like someone said you were just "obese". If they suggested that you appeal, then the person you spoke to may have realized that the wrong term was used.
   — M B.