Question:
Any success againt UHC Exclusions & Limitations Clause?
UHC changed our Exclusions & Limitations clause to include the terms 'morbid obesity' when stating all services and therapies are excluded. They also took out the 'Unless Medically Necessary' clause. My surgeon just submitted last Friday before we even received the new policy. I'm already anticipating a battle - does anyone have recent experience with United HealthCare and their exclusions?? — Ginny D. (posted on July 31, 2003)
July 31, 2003
I don't have the answer you are looking for but I do have my own experience
with UHC Texas. I had absolutley NO problem getting approved for surgery on
May 27, 2003. I don't know what state you are in but I too received the new
policy. They have paid for everything! They approved surgery in 3 weeks.
Good Luck and don't give up.
— Mindy B.
July 31, 2003
Wow I am sorry to hear that, I have UHC EPO, and was approved last
week....I have it through my husbands work and usually get everything in
April. Almost everyone I have heard that has UHC says they are approved in
no time, is it through an employer? I have heard they have the choice of
what to include and exclude.
— Saxbyd
July 31, 2003
Ginny, I have had very recent experience with UHC Choice Plus HMO. WLS is
listed as an exclusion for me with no mention of medical necessity. The
frustration was amazing for me as I got a different answer with each person
I talked to. I have been denied on first application, and am getting ready
to submit an appeal. I am not hopeful, however, and have already made plans
to take on my company's insurance (I'm currently on hubby's plan) in
November. The best thing I can tell you is do not leave this process in the
insurance nurse's hands. Do the first application for pre-cert yourself. Be
fairly thorough, citing all the normal stuff. If you need the address of
where to send it, email me and I'll be happy to give it to you. I can also
share my letters if you're interested. Good luck to you!
— SweetDragonfly
July 31, 2003
Ginny, Sorry but I can't tell you that I had success with UHC. I had the
same exclusion and was denied twice before my company changed insurance
policies. They weren't even willing to add on an addendum for my
situation. I ended up getting new insurance that had an exclusion too and
self paid. See my profile for my surgeon who did my whole surgery, total
cost was $6900. Good luck to you!
— SMG I.
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