Question:
I have UHC PPO and my exclusion states:
Has any one been approved even though they have this exclusion? Surgical and non-surgical treatment of obesity, including morbid obesity. It does not say anything about medically necessary and when I called they said to send a pre-determation letter. — Tonya D. (posted on April 8, 2003)
April 8, 2003
I would assume that they want what mine does, a letter from your PCP
stating why they feel that you should have this surgery. Have you exhausted
all the other options? have you done the WW, JC< and possibly
prescription drugs to help you lose weight along with a supervised diet?
Have you done anything like meet with a nutritionist? A psych eval? an
exercise program?
— Beverly S.
April 8, 2003
I have UHC, PPO also and my policy states the same thing except mine says
if other medical reasons caused by the weight such as high blood pressure,
heart problems, sleep apnea, etc. then it will cover it. I had my approval
in two weeks after sending in the letter from my doctor saying why it was
medical necessary for the surgery. open ryn June 7th, 2002, 150# loss.
Cathy
— Cathy S.
April 8, 2003
I have UHC PPO and Cathy is right. I had the same exclusion. I had heart
palpitations and high blood pressure and was approved in two weeks. If you
have some co-morbid you will not have any problems getting approved. If
you don't, talk with the doctor to make some up like joint pain. You'll
get approved. Good Luck! UHC is a very good health plan, I love them.
— Adele S.
April 9, 2003
I have uhc ppo and my exclusion states the same surgical and non surgical
for treament of obesity (morbid obesity) is excluded. I called them and
spoke with a rep and told him I have diabetes and other weight related
problems and he said that if the surgeon can get the right paperwork over
to them that there should not be a problem approving the surgery even with
the exclusion. oh happy day!!!! good luck:)
— harleigh2002
April 9, 2003
I've got UHC PPO, and I didn't have a problem at all getting approved. I
had a letter from my pcp, my surgon, and sent over 5 yrs of medical
records. I was told there was no exclusion if it was determined medically
necessary. Good luck, and God Bless
— mellyhudel
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