Question:
My Insurance (UHC) denied coverage
I belong to a small group and UHC automatically does not offer coverage for bariatric surgery for small groups. I am planning to appeal this decision, especially since I have already met all the requirements that Dr. Overcash sets. Does anybody have experience with appeals like these and is willing to share how they went about their appeal. THANKS — juschi (posted on November 1, 2007)
November 1, 2007
Hello, If your Insurance does not offer Bariatric surgery then it won't
matter how many appeals you do. To get this surgery paid for your Insurance
has to offer this as one of your coverage. What I did is when open
enrollment came I change from bluecross to a company I new would cover
this. I change to cigna and then went throw the steps. I got turned down 3
times and then I started an appeal and sent my recoores from the Obesity
clinic and from my everyday Doctor. It was a pain, but I got a yes after
this. You should check to see what your job offers to you and call each one
to see if this is covered and then change to that one. You can't make an
insurace company to pay for anything they don't offer no matter what a
Doctor says. I hope I was help.:)
— aluvzu2
November 1, 2007
Hi Jutta....
I had UHC last year and it did cover my surgery for the RNY in December. I
am working for a large corporation so I don't know if that makes a
diffrence. I would try to fight if you can. I know that my doc told me
that UHC was one of the better insurances to have that will cover the
surgery. But, it also matters what your company decided to cover when then
got the plan. I wish you good luck and let me know if you need any other
info........Ronda
— Ronda C.
November 1, 2007
Hi Jutta, I would have to agree with other responders, if UHC with your
employer say they won't cover, I wouldn't waste time with an appeal! I have
Anthem BC/BS(large company), excludes all WLS!!! I am know coming to terms
with want I am willing to pay for my health and well being. I will be self
paying for my WLS. EMS55
— EMS55
November 1, 2007
Hi Jutta,
My husband works for a small business that has UHC with the WLS
exclusion. The company owner had gall bladder and hernia surgery, plus lap
band. She had to self pay the doctor & hospital. Good luck with
whatever you do.
— Jean Hitchcock
November 1, 2007
I work for a lawfirm and there is 300 people.
We had UHC and they only let me appeal twice. There was an exclusion. They
did not care if it was medically neccesarry or not. But I would appeal, it
is worth it if you are the one in one million that they did. You will never
know till you try.
— dawnspaints
November 1, 2007
We have a company here in Houston called Newiegh, they are dedicated to
helping individuals dealing with their insurance companies. They do all of
the appeals and leg work for you. You may be able to give them a call and
at least get the correct forms you need and led you in the right direction.
They helped me and 3 co workers. There # is (713)795-0200 Good luck!
— jmallett
November 1, 2007
I also have UHC and work for a small company...there is an exclusion and
unfortunately you can appeal till you are blue in the face...and exclusion
is an exclusion and no matter how medically necessary it might be they will
not cover it...you are better off looking into changing insurance companies
with a plan that does cover it. Good Luck
— JodieZ
November 2, 2007
I would still appeal. You have rights to appeal you should appeal. Don't
take no as answer. If you need help with your appeals I can help you.
— Kjackson2
November 2, 2007
I think this is redundant as everyone is saying the same thing. :)
Unfortunately if they have an exclusion on the policy, they just won't
cover. A lot of smaller companies, but some bigger ones as well, have
self-funded insurance and they regulate what to pay and not. I don't know
all the ends and outs, but that's a short/sweet version. However, I would
still appeal. You may get no where, but maybe the more people that DO
appeal these kinds of things, maybe it will help change the system. Who
knows. I would also contact your benefits rep and talk to them about it and
see if your company offers another ins that may cover this. If that doesn't
work, there is always self pay. I know, I wouldn't want to go that route
either, but it's just how serious you really are about wanting this and
what you can genuinely afford. Good luck!!
— juliebelle0402
November 4, 2007
thank you all so much for your opinion and advice. Here is a new question.
I am serious enough to debate self pay. Does anyone have any pricing info
in Central Florida ( or east/west coast) for self-pay?
Thanks again.. It so helps to know there are others out there.
— juschi
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