Question:
has any one had a policy with united health care that had an exclusion against
gastric bypass surgery but finally got it approved anyway.do you have any tips to help me? — Pamela R. (posted on February 15, 2002)
February 15, 2002
Pamela....I have United Health Care Select. They were thinking of writing
in WLS as an exclusion this year, but they didn't. The only stipulation is
"the medical need", so they require a letter from your doctor. I
was approved on 1st submission in January. Just be sure to include a letter
of need from your doctor when you apply. You shouldn't have a problem.
Bonnie H.
— Bonnie H.
February 15, 2002
i am employed by united health care, the employer(usually) sponsoring the
insurance benefits dictates whether or not the surgical or pharmaceutical
treatment of obesity is a covered benefit, not the insurance company. your
question is confusing, in one sentence you say its an exclusion, the next
you say its going to be covered... can you clear that up, please.. it
should say in your benefit information,the exclusion should be stated.
because there are a lot of united health care plans,policies and offices
the best source of information regarding your benefits,is the benefit phone
number listed on your card. if they say its a specific exclusion you can
appeal, but those are hard appeals to fight as the employer has a right to
state whether or not they want to cover the treatement of obesity. i hope
things work out the way you want them too..
— LisaK/ UnstapledLisa
February 15, 2002
This is an addendum to my last answer. While I love the support one can get
from obesityhelp.com and other online and offline support groups as it
applies to surgery and/or experience, You never want to use these groups as
a form of insurance benefit information. Everyone's policies can
drastically differ with the same insurance company and whether someone has
UHC,Aetna,Cigna etc, the insurance coverage varies quite drastically
between the same insurance company as most of the time the coverage is
dicated by the employer or entity(i.e. medicare,medicaid) sponsoring the
insurance benefit.When one responds to a post about about insurance, please
keep in mind if you have the same insurance company as someone who is
inquiring chances are your policies vary quite drastically. If weight loss
surgery is a specific exclusion and you get a denial that is the hardest
denial to fight. If its a denial based upon review for medical necessity
you may have a chance, I can explain any of the components of this
response, personally if you like,regardless of who your insurance is
through, please email me privately on my link with obesity/insurance in the
title. Thanks, Lisa
— LisaK/ UnstapledLisa
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