Question:
What is the next step when appeal is denied?

My company is United Health Care Choice Plus. They have an exclusion clause that says the following is excluded: "medical or surgical treatment for obesity or for reducing or controlling weight, unless otherwise specified in the covered services provision." The covered services provision discusses medical necessity. My appeal letter discussed the differences between obesity and morbid obesity (since that wording was not used) and discussed my reasons for medical necessity. I was told over the phone that is was not a covered benefit. When I told her that the clause does not address morbid obesity, she stated that there is only one obesity. What should I do know? I have already contacted the Attorney General's office. Would it do any good to write another appeal letter.    — Jackie L. (posted on January 23, 2001)

June 20, 2001
First, ignore the very intelligent woman who said there is only one obesity. What a joke!!! Second, arm yourself with information! Go to the National Institues of Health website or other health related websites and find a clear definition that distingushes between obesity and morbid obesity. Also look at the Americans with Disabilities Act, and most importantly, DON"T GIVE UP! That's what they want you to do!
   — Jami H.