Question:
medically necessary but denied because of exclusions.. help!

I am again searching for help to begin again my fight!.. I have United Health Care..HMO and have been referred by my primary physician both him and the surgeon stated in the letter that this was medically necessary.. I passed the psychological exam.. stated I was of sound mind to have this procedure.. and then was denied because of exclusions in my policy... can anyone get me on the right track with examples of appeal letters?? I last year developed diabetics and had to have emergency gall bladder removal as well...thanks.. Irma    — rinkadinktx (posted on September 22, 2002)

September 22, 2002
UHC will not override an exclusion. Sorry to be the bearer of bad news, while they are very liberal about approving this surgery, they stick to the exclusion if one is in the policy. I work there and two months after I had surgery the exclusion was added to the UHC employee policy. Not because of me......there have been MANY employees that have had this done. Why it was added is still unclear to me. There are strict guidlines that are followed regarding the approval of services. Exclusions are added by the employer and not the insurance company.
   — RebeccaP

September 22, 2002
it sounds to me like if the Employer is Discriminating, that is who your recourse would be against.
   — Darlene P.

September 23, 2002
uhc will not overturn an exclusion believe me I have tried EVERYTHING sorry even a lawyer wont help I tried that too sorry to be the bearer if you ever have any luck that I didnt let me know GOD bless you
   — CARLA C.