Question:
My Insurance (UHC) denied coverage

I belong to a small group and UHC automatically does not offer coverage for bariatric surgery for small groups. I am planning to appeal this decision, especially since I have already met all the requirements that Dr. Overcash sets. Does anybody have experience with appeals like these and is willing to share how they went about their appeal. THANKS    — juschi (posted on November 1, 2007)


November 1, 2007
Hello, If your Insurance does not offer Bariatric surgery then it won't matter how many appeals you do. To get this surgery paid for your Insurance has to offer this as one of your coverage. What I did is when open enrollment came I change from bluecross to a company I new would cover this. I change to cigna and then went throw the steps. I got turned down 3 times and then I started an appeal and sent my recoores from the Obesity clinic and from my everyday Doctor. It was a pain, but I got a yes after this. You should check to see what your job offers to you and call each one to see if this is covered and then change to that one. You can't make an insurace company to pay for anything they don't offer no matter what a Doctor says. I hope I was help.:)
   — aluvzu2

November 1, 2007
Hi Jutta.... I had UHC last year and it did cover my surgery for the RNY in December. I am working for a large corporation so I don't know if that makes a diffrence. I would try to fight if you can. I know that my doc told me that UHC was one of the better insurances to have that will cover the surgery. But, it also matters what your company decided to cover when then got the plan. I wish you good luck and let me know if you need any other info........Ronda
   — Ronda C.

November 1, 2007
Hi Jutta, I would have to agree with other responders, if UHC with your employer say they won't cover, I wouldn't waste time with an appeal! I have Anthem BC/BS(large company), excludes all WLS!!! I am know coming to terms with want I am willing to pay for my health and well being. I will be self paying for my WLS. EMS55
   — EMS55

November 1, 2007
Hi Jutta, My husband works for a small business that has UHC with the WLS exclusion. The company owner had gall bladder and hernia surgery, plus lap band. She had to self pay the doctor & hospital. Good luck with whatever you do.
   — Jean Hitchcock

November 1, 2007
I work for a lawfirm and there is 300 people. We had UHC and they only let me appeal twice. There was an exclusion. They did not care if it was medically neccesarry or not. But I would appeal, it is worth it if you are the one in one million that they did. You will never know till you try.
   — dawnspaints

November 1, 2007
We have a company here in Houston called Newiegh, they are dedicated to helping individuals dealing with their insurance companies. They do all of the appeals and leg work for you. You may be able to give them a call and at least get the correct forms you need and led you in the right direction. They helped me and 3 co workers. There # is (713)795-0200 Good luck!
   — jmallett

November 1, 2007
I also have UHC and work for a small company...there is an exclusion and unfortunately you can appeal till you are blue in the face...and exclusion is an exclusion and no matter how medically necessary it might be they will not cover it...you are better off looking into changing insurance companies with a plan that does cover it. Good Luck
   — JodieZ

November 2, 2007
I would still appeal. You have rights to appeal you should appeal. Don't take no as answer. If you need help with your appeals I can help you.
   — Kjackson2

November 2, 2007
I think this is redundant as everyone is saying the same thing. :) Unfortunately if they have an exclusion on the policy, they just won't cover. A lot of smaller companies, but some bigger ones as well, have self-funded insurance and they regulate what to pay and not. I don't know all the ends and outs, but that's a short/sweet version. However, I would still appeal. You may get no where, but maybe the more people that DO appeal these kinds of things, maybe it will help change the system. Who knows. I would also contact your benefits rep and talk to them about it and see if your company offers another ins that may cover this. If that doesn't work, there is always self pay. I know, I wouldn't want to go that route either, but it's just how serious you really are about wanting this and what you can genuinely afford. Good luck!!
   — juliebelle0402

November 4, 2007
thank you all so much for your opinion and advice. Here is a new question. I am serious enough to debate self pay. Does anyone have any pricing info in Central Florida ( or east/west coast) for self-pay? Thanks again.. It so helps to know there are others out there.
   — juschi




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