Question:
United Health Care POS-not having 5 yrs of being MO

My sister is in the early stages of being approved for surgery, she lives in sothern Indiana and her surgeon is in Kentucky. Well, she just received word (verbal) from her insurer that she has been denied due to the fact that she does not have 5 years of being MO, she just has 2 years of being MO and 5+ years of just being overweight. She is waiting for the offical written paperwork of what the exact wording is on the denial. Has anyone with United Health Care POS gotten around this kind of a denial? She is gearing up for an appeal in the near future but she is waiting for her offical written paperwork. Any info that you may have would be appreciated. Thank you.    — ChristineB (posted on May 31, 2006)

May 31, 2006
Your sister may want to check with Indiana Insurance Standard of Review for bariatric surgery. The State of Maryland has one and any one living in MD that works for a company with 50 or more employees can't be denied. I'll look to see what I can find about Indiana. The insurance companies are counting on people not knowing the law. The states have a compelling interest in this because it will eventually spin down their medicaid/medicare costs.
   — the7thdean

May 31, 2006
some companys do a automatic denial for the first request. i was so i was approved on the first appeal within a couple weeks. tell her not to give up. good luck keep fighting
   — hjdj70

June 1, 2006
I live in southern Indiana and my surgeon was in Kentucky as well. I had my surgery on December 19, 2005. United Health Care approved me on the first go round. You may want to try to get your family physician to write a letter about your weight struggle. It may help to get you approved. Don't give up. Keep trying. I was 257 lbs now I'm 169 already. It's worth it. Good luck!
   — PopcornRobyn

June 2, 2006
I don't know what center she is going through, but the barix clinics have some agreement with uhc pos. i was approved 1st try.
   — jeffmi