Question:
Denied coverage by United Healthcare, now what?

I spoke with the insurance company today.....the wording in my policy is: 1. Weight loss program for medical reasons are excluded. 2. Surgical and non-surgical treatment of obesity, including morbid obesity. It was my understanding that if it was life-threatening and/or medically necessary it would be covered....the wording in the policy is vague...my other insurance specifically says "surgical treatment for obesity or morbid obesity, is not covered even if medically necessary" Has anyone else run into this problem? What did you do? Is it possible to get around it? Should I go through the appeal process? Does anyone have any examples of letters that they could send me? I would appreciated any help anyone could give me.    — Julie D. (posted on March 18, 2003)

March 18, 2003
I don't have an answer for you, but am very close to my appointment at which my surgeon will submit the request for approval to United Healthcare. I don't know which plan you have, but I am on the point-of-service plan. The surgeon that I am seeing is not contracted with United, so at best they will cover 50% of the reasonable and customary charges. My doctor, Steven Patching, hasn't had problems in the past and to my knowledge has worked with United before. I really hope that I don't run into the same problem, and I sincerely hope that the situation changes for you as well. If I am going to be denied, I will know soon. I see Dr. Patching on April 1st, and to my understanding I will get a tentative date at this visit. I will let you know if I am approved or denied. The thing that amazes me is, I have spoken to quite a few of the customer service reps at United and none of them stated that the surgery is not a covered benefit. Lots of luck and well wishes to you.
   — Leesa_here

March 18, 2003
Julie, I am very sorry that your insurance policy has the exclusion. There is an entire section on this site devoted to dealing with insurance problems, including appeals, letters, etc. Get over there and start planning your attack. Other options include hiring a lawyer (obesitylaw.com claims a 50 percent success rate in getting exclusions overturned, and claims to charge less than $500, no matter what state you live in); enlisting your employer to get the exclusion eliminated. I know this is discouraging, but please don't give up. That is exactly what the insurance company wants you do do. I am certain that in five years, exclusions for WLS will no longer exist, and will be because people like you fought this injustice. Good luck!
   — Kasey

March 18, 2003
I also have UHC and was denied for exactly the same reason. I notified my HR rep and she worked with them and we were able to get it approved.
   — Sharon F.

July 17, 2003
Well said, Kasey! I also have UHC and I just found out that I was denied due to an exclusion by my employer...the last true ignorance is in thinking there is any reason to deny this life saving surgery! I am trying to overturn it with an appeal. I will call everyday until they're sick to death of me. Then, if my appeal is denied, I will hire a lawyer to help. Go through the appeal process!!!! If it is worth it to you, then you MUST do it!
   — SweetDragonfly