Question:
B&N employee (in NC) w/UHC PPO told I am completely excluded!!!???

ok, i spoke to UHC who said that there is a plan exclusion w/my employer and they will not cover anything weight loss related. i spoke to the HR dept and they advised that there is such an exclusion, but that i should have a preservice/preauthorization letter from pcp which will be denied then i can file an appeal. has anyone else encountered this????? what do i do with this????? i have a bmi of 46.5, comorbidities (hypothy, which is reason for weight gain in the fist place; diabetes, now i'm having stomache ulcers and severe gi problems). please advise...i feel i'm at such a loss here.:(    — Jess R. (posted on February 8, 2003)

February 8, 2003
Jess, Don't give up yet. Go ahead and formally request authorization for surgery. Your insurance will deny it in writing, then take the denial to your HR department. If your company is self-insured, meaning they actually pay the medical claims, with the insurance company acting as the contracted plan manager, then your company has the right to overturn the denial. It doesn't mean they have to, but many companies will. If your company is NOT self-insured, which means they pay insurance premiums and the insurance company pays the medical claims, it will be harder to get approved, but it is possible. First, ask if they are willing to request that the insurance company remove the exclusion. Many insurances will not, including Blue Cross Blue Shield, but you have to ask. If all insurance options fail, ask your employer if they are willing to help you pay for the surgery since your insurance has this discriminatory exclusion in it. Keep fighting, and eventually all insurance companies will have to pay for this medically necessary, life-saving procedure. Best of luck to you.
   — Ginger N.