Question:
Any one had luck getting approved with UHC PPO with an exclusion?

I work for a medium sized school district in Texas. I called the insurance co. to see if ther were any exclusions for WLS, they said there was one. She read it to me and I didn't hear any ways around the exclusion. Has anyone tried to get approval with this insurance with an exclusion?    — helloitsme (posted on January 8, 2006)

January 8, 2006
i dont know that our policies are the same but i had my wls in april, i paid for everything up front out of pocket, per my uhcppo saying it was not covered and no exclusions. i still had the surgeon and the hospital bill my insurance, and they have refunded me all of my costs. i dont know if this is the way uhc works, just makes you pay up front and then they have to pay it, or if i got lucky, or what. but i do know its worth it even if i didnt get paid back. i did a home equity loan to get my money. good luck to you, i know it breaks your heart being denied at every turn.
   — moreismore69

January 8, 2006
I have UHC and it has a weight loss exclusion. I even wrote the insurance commison and thy dod not pay a dime . I had to do self pay......... Good luck
   — ekmeadows

January 8, 2006
I also have UHC and work for the State of Ohio. They denied my first request for surgery claiming their is a exclusion for weight loss. My Dr. however contacted a lawyer group for me and found that with my comorbidities that the surgery could possibly be approved. My appeal has been in review now for 5 weeks and may not be determined for another 8 weeks so says the insurance company. Even if denied again I am sure I will somehow pay for this myself. Mike [email protected]
   — Michael

January 8, 2006
I work for an elementary school in Georgia. I also had UHC. I tried every avenue to get approved even with the exclusion but they would not budge. I contacted our Governor and the State Board of Directors to get approved and they told me they would not approve it due to it being a cosmetic WLS and there were to many difficulies afterward. All my screams fell on deaf ears. I went with my husband insurance once I cancelled mine and was approved in two weeks(BC/BS). What ever you do don't give up. If it is meant to be then it will be. I am 3 months post op. DON'T GIVE UP!!!!!
   — kchurchwell

January 9, 2006
Some UHC policies pay, some don't. Regardless, most of the time they will tell you it's not covered when you call. The customer service people typically are not trained to look up specific info on specific policies; just procedures and whether they are covered or not by uhc. WLS is auto denied in one of thier computer platforms, regardless if you policy covers it or not. As an example: I worked for UHC when I had my WLS, I knew my policy inside and out (that was my job)...anyhow, the phone reps told my surgeon it was not a covered benefit. (before I get 50 emails again...I don't work there anymore. LOL)
   — RebeccaP