Question:
I have United Healthcare PPO Options in Texas with and Exclusion

My employer has an exclusion in my policy that states will not cover any weight loss programs. I called the customer service department and they advised that I am not covered for weight loss surgery. Should I persue the claim with the insurance company and send a letter of pre-determination anyway? Should I then appeal if I am denied? What can I do to get approved? Where do I get a complete copy or full copy of the coverage?    — Nelle P. (posted on May 31, 2004)

May 31, 2004
Get a copy of your full policy. This is NOT weight loss surgery per se. Fight the exclusions expecially if you have co-morbitities. Good luck
   — gary viscio

May 31, 2004
It can't hurt to try. But I do agree, you need a copy of your policy's limitations and exclusions page. BTW, most phone center people don't know the exact coverages of your policy anyway. Don't get too discouraged, nor should you get your hopes up too high.
   — RebeccaP

June 1, 2004
you should try. follow the previous 2 posters advice. but it is also good to work with your human resource in trying to appeal. if you company is self funded and are able to overwrite an exclusion this would be the fastest way to have surgery approved. but you will most likely need to prove that you are medically necessary to have this surgery. good luck!
   — manalden55

June 1, 2004
Not good news from me I am afraid. I too had UHC TX, same thing, company had excluded weight loss surgery blah blah blah...same as yours. I changed insurance when my husband got different job...a month and 5 days later I had my surgery. Good luck. And dont give up...I didnt, and it was the smartest thing I have ever done ( other than my husband hehe) Hugs to you.
   — victoria W.

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