Question:
any way around an exclusion that includes, obesity and morbid obesity
i just received my first denial from uhc, states that there is an exclusion for any treatment for obesity or morbid obesity, surgical, medical, etc. my employer is really supportive and spoke w/ the insurance broker-- I had looked on the "my uhc" website a month ago- several types of surgery were covered (I need/want RNY)but it said to check your particular plan for exclusions. now, i can't even get to the benefits section on the website- I tried the same day i rec'd the denial w/ no luck. the broker says w/o some proof i saw that as a "possible" benefit that there is no way to fight it. any ideas???? Please help. thanks — Leigh S. (posted on July 27, 2002)
July 27, 2002
I don't know about your specific state laws, but I would do some research
into obesity discrimination law. When my employer looked at taking the
benefit away the benefits manager told me that because of the obesity laws,
we could not exclude the surgery. Good luck.
— Joanie J.
July 27, 2002
I have UHC myself. You will not find the exclusios or the surgeries covered
on the myuhc.com website. It is only located in your certificate of
coverage and benefits book they provide each year. You can also call UHC
customer service and ask for a copy to be sent out. I was lucky that I did
not have any exclusions, remember UHC does not set those exclusions, your
company almost always does. Good luck!
— Stephanie B.
July 27, 2002
The previous poster is incorrect on her statement that the employer, not
UHC, sets the exclusion. Tht only applies if you work for a large
employer (one that has 100+ employees on the plan). If you work for a
small employer, the UHC plans and exclusions are set by UHC and your
employer has NO control over the exclusions whatsoever. It sounds like
your plan is a small group plan (under 50 employees) and being an insurance
agent, I can tell you, UHC exclusions for surgery on small groups is iron
clad and it wont be covered.
— Patty H.
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