Question:
Any suggestions on how to get around an exclusion? United Healthcare of the Midwest (ChoicePlus Sel

I have been contacted by my insurance company that surgery for specifically for the control of morbid obesity is a general exclusion on my policy and it will not be covered. I will still be keeping my appointment with Dr. Mitchell in St. Louis on Feb. 22nd but was wondering if there was anyone in Kansas or Missouri that has the same policy that I do and if they had any success in getting around the exclusion. I'm taking any and all suggestions. No matter what I'm having surgery, I just feel (as do my employers) that for what we pay in insurance premiums that this is totally an outrage. While researching my policy I found out that they will cover penile implants if it can be shown to have a psychological effect not to have one. They also cover Viagara. I can't even get birth contol pills on my prescription card! Thanks in advance for you help!    — Michelle R. (posted on February 11, 2001)

February 11, 2001
Oh Can I bash United Health care!!!! I am in Ohio, but I have United Health care and you are saying the very exact thing I am currently appalled over! How can they justify a penile inplant? It had to be a man who wrote out the exclusions - they think they can't live without that thing - but they can. Okay - is your employer self insured? If they are self insured and they feel the same way you do then they should be able to change the exclusion or allow it anyway. If they aren't self insured then you should fight it on the grounds of medical necessity. But if you go to your appointment before the insurance has approved it, then you may loose your appeal because they could either say you weren't following procedure or that it is a pre-exisiting condition. I hate to say this because I know how you want it and want it now - but unless it is an emergency,or you just have the money to self pay I would reschedule my appointment. This is getting long - e-mail me and I will tell you the information I have so far and read my profile for my latest reason to loathe United Health Care.
   — K T.

February 11, 2001
I have United Health care select. I am surprise that they won't cover your surgery. You may have to appeal it through your employer. Sharon
   — Sharon T.