United Healthcare (UHC) - One WLS Per Lifetime Limit - Seeking positive REVISION success...
I had RNY in 2003 and am in need of a revision to DS due to complications, weight gain and a "mechanical failure" of the RNY pouch - in that I have a fistula.
I was wondering how we may be able to get around the one surgery per lifetime issue with UHC? If you have had any success or have ideas, please let me know.
From everything I've read here there is no way around it and you will have to self pay. Only the employer or whoever buys the insurance can change the type of policy coverage so unless you can get them to change coverage on the policy you are out of luck. Many have had the same problem and ended up having to go out of the country to get surgery so they could afford it.
I am looking for more people who have fought this and won. First of all, I cannot afford self pay and I understand there are ways around this if there is a serious complication like what I have ... Something needs to be done as it could lead to life threatening issues. If a person has cancer surgery and has another tumor or issue do they just let you die and make these rules? Not acceptable and I won't stop until I win! I am looking for positive replies please.
Doug this is too difficult to explain on this forum, but there are reasons, limited as I stated in my earlier post. you should still try to appeal this, if you can demonstrate you NEED a DS. I wish you only the best in your search
If you have a specific question for me, PM me or I will not see it, as I don't check responses on the forums and don't have anything forwarded to my email.
I am looking for more people who have fought this and won. First of all, I cannot afford self pay and I understand there are ways around this if there is a serious complication like what I have ... Something needs to be done as it could lead to life threatening issues. If a person has cancer surgery and has another tumor or issue do they just let you die and make these rules? Not acceptable and I won't stop until I win! I am looking for positive replies please.
no,if a person has cancer and get another tumor,it is covered because cANCER treatment is a covered benefit. It is not considered elective like Wls is considered.
I assume you meant well - but I wasn't encouraged. I am looking for people and comments that concern good ideas and solutions to WIN here with the insurance. There are many I have found that have had some success with UHC with revisions. That's what this post was about!
Who says WLS is elective? It is no more elective than if a person has cancer chooses to get treatment to cover the illness. Obesity is a serious life threatening illness. We need to get our heads around this fact.
Yes bariatric surgery is elective, the definition of elective is anything that is scheduled in advanced, including a tumor, cancer, open heart, etc. There is a major difference between elective and medically necessary and policy exclusions. keep asking questions and doing more research, you are an individual and there are no absolutes in medicine and hopefully you will get some positive news soon.
Edit: Also could you see the outcry if an insurance company denied cancer treatment? Immediatley resolved, but if an insurance company denies, and policy excludes obesity, it is accepted. That is the problem, ignorance, and insurance companies allowed to get away with it. If obese patients rallied together this would be different as in the federal law changed for The Women’s Health and Cancer Rights Act.
If you have a specific question for me, PM me or I will not see it, as I don't check responses on the forums and don't have anything forwarded to my email.
I assume you meant well - but I wasn't encouraged. I am looking for people and comments that concern good ideas and solutions to WIN here with the insurance. There are many I have found that have had some success with UHC with revisions. That's what this post was about!
Who says WLS is elective? It is no more elective than if a person has cancer chooses to get treatment to cover the illness. Obesity is a serious life threatening illness. We need to get our heads around this fact.
well,you are wanting ppl to tell you what you want to hear. We can only tell you the facts as we know them.
It doesn't look like there is anyone who has been successful in overturning a one surgery only clause. You can't make it happen just cause you want it to happen.
Insurance companies are the ones who determine what is elective and what is. Not. Even most surgeons will tell you that WLS is an elective procedure. He fully one day that will change,but for now it is what it is.
I have been on this board for 7 years and have never read where anyone has successfully overturned the one Wls clause.
Thank you for your note and sincere outlook. I have read about 6 success stories so far on this board of others that appealed and used different avenues to succeed. Has anyone heard of www.wlsappeals.com?
Again, the reason I was posting this thread is to talk about how to win with the one WLS per lifetime clause.
I will tell you one thing - I will prevail with this surgery and I WILL figure out how to have my insurance cover the 2nd operation. And it wont be too long either. That is my mission and I rarely will be stopped.
Yes Walter and Kelly are amazing, they will work hard to resolve your adverse decision. The insurance co will also move much faster with them on board. Yes used them with a very positive experience
If you have a specific question for me, PM me or I will not see it, as I don't check responses on the forums and don't have anything forwarded to my email.
