Question:
Do I have a chance to fight this exclusion?

My written exclusion by selffunded employer in UHC epo policy states, "no benefits availible for surgical or nonsurgical treatment of obesity or morbid obesity." does this exclusion mean it will not cover procedure if medically proven necessary. can i make this assumption or is this a vague in wording and possibly worth appealing. i have been denied initially and have placed my first appeal with documentation that proves without a doubt medical necessary. from what i have read and respsonse it seems like most experiences have been poor in approval. has anyone had similar experience, good or bad let me know.    — manalden55 (posted on May 16, 2003)

May 16, 2003
My sister has a similar exclusion in her policy. (Not UHC) She was denied and filed an appeal. We had a hearing....at the hearing they agreed that the surgery WAS medically necessary...but stated that it was just simply not a covered procedure. Denied and case closed. :( She then went to work for Home Depot part time. They offer part time benefits and there is NO exclusion in the policy. She has had her consult with the Bariatric Treatment Center in Scottsdale Arizona about a week ago and is now in the dreaded waiting game. Wish her luck!!!
   — skymaxjr

May 16, 2003
Absolutely fight this..I am in process of same going into second appeal and requested peer to peer mediation for my doctors. Don't give up, there may be laws in your state to help you with this, contact your state insurance commission if all appeals fail. They expect you to give up after the denial, keep going it will be well worth it.
   — sheila F.