Question:
Any success againt UHC Exclusions & Limitations Clause?

UHC changed our Exclusions & Limitations clause to include the terms 'morbid obesity' when stating all services and therapies are excluded. They also took out the 'Unless Medically Necessary' clause. My surgeon just submitted last Friday before we even received the new policy. I'm already anticipating a battle - does anyone have recent experience with United HealthCare and their exclusions??    — Ginny D. (posted on July 31, 2003)

July 31, 2003
I don't have the answer you are looking for but I do have my own experience with UHC Texas. I had absolutley NO problem getting approved for surgery on May 27, 2003. I don't know what state you are in but I too received the new policy. They have paid for everything! They approved surgery in 3 weeks. Good Luck and don't give up.
   — Mindy B.

July 31, 2003
Wow I am sorry to hear that, I have UHC EPO, and was approved last week....I have it through my husbands work and usually get everything in April. Almost everyone I have heard that has UHC says they are approved in no time, is it through an employer? I have heard they have the choice of what to include and exclude.
   — Saxbyd

July 31, 2003
Ginny, I have had very recent experience with UHC Choice Plus HMO. WLS is listed as an exclusion for me with no mention of medical necessity. The frustration was amazing for me as I got a different answer with each person I talked to. I have been denied on first application, and am getting ready to submit an appeal. I am not hopeful, however, and have already made plans to take on my company's insurance (I'm currently on hubby's plan) in November. The best thing I can tell you is do not leave this process in the insurance nurse's hands. Do the first application for pre-cert yourself. Be fairly thorough, citing all the normal stuff. If you need the address of where to send it, email me and I'll be happy to give it to you. I can also share my letters if you're interested. Good luck to you!
   — SweetDragonfly

July 31, 2003
Ginny, Sorry but I can't tell you that I had success with UHC. I had the same exclusion and was denied twice before my company changed insurance policies. They weren't even willing to add on an addendum for my situation. I ended up getting new insurance that had an exclusion too and self paid. See my profile for my surgeon who did my whole surgery, total cost was $6900. Good luck to you!
   — SMG I.