Question:
Anyone denied a revision with a UHC policy exclusion....

and then won subsequent approval. I need help! My policy has an exclusion for WLS. However, UHC is saying this surgery can be covered if medically necessary. They are not seeing the dilation of my pouch as medically necessary. All I get from them is a letter saying it's an exclusion and not based on medical review. I am trying to argue the point that this is a revision of surgical treatment for obesity and not a request for initial surgery. I am also arguing (to no avail) that there is no specific policy language that supports ther denial of my revision. I have contacted the Attorney General's office, the insurance commissioner and I am now writing letters to state legislatures. I am desperate to have this revision. Any and all suggestions would be appreciated.    — Sandra C. (posted on December 1, 2004)

Sorry, no answers yet. Perhaps you have one to contribute.