Question:
How do I go about getting my insurance exclusion turned into an approval?

I have United Healthcare choice PPO and in my benefits pack it states that any treatment surgical and non surgical for obesity (morbid obesity) is excluded. How do I change that and has anyone with that wording gotten approved?? I have a consultation with my surgeon and he is listed in my group of providers on April 25th.    — harleigh2002 (posted on April 1, 2003)

March 31, 2003
From what I hear on this board, it is nearly next to impossible to get an exclusion like that overturned. I have UHC and I had an exclusion also but mine said EXCEPT for medical necessity.
   — Delores S.

March 31, 2003
Not to be negative, but generally an exclusion is pretty straight foward. Two years ago, I tried to have WLS, but my husbands Blue Cross Insurance had an exclusion. I contacted Walter Linstrom and he told me (much to my dismay)that there was no way around it. Thank God for a new job and insurance that covers this surgery. Good Luck!
   — J. Wilkinson

April 1, 2003
First of all, you need to check and see if your insurance through your employer is a self funded plan. If so, the employer is the one who "chooses" what the plan covers, so it may be that an employer can request to "override" the exclusion. I also have UHC and am waitintg to submit for approval and I also have a written exclusion. In order to try to circumvent an immediate denial, I have included a letter where I point out to them how much UHC has paid out over the last two years for me (from claims info on their website). In my case, they should approve on "business necessity" for them if they don't want to approve on medical necessity for me. They have already paid out about 175% of the surgery cost in claims for me for the past two years. The cost of surgery would pay for itself many times over.
   — Debbie B.

April 1, 2003
check the wording of the exclusion and state law. I am helping a friend with hers in NY. Same deal with UHC. But I have a bunch of caselaw on point. Email me if you have any questions. [email protected] thanks Gary
   — gary viscio