Question:
UHC of KY exclusion - way around it, or company add it?

I've just found out that my company's policy has a SPECIFICALLY EXCLUDES any/all surgery for weight loss clause and, after speaking with customer service reps at UHC, was told no matter how many letters my PCP or the surgeon writes, it won't make a hill of beans difference because of my company's policy and the iron-clad exclusion clause. My question is two-fold: Has anyone successfully gotten around this? And two: if your employer has added the inclusion of this surgery, how long did it take to come into effect? Please share your experience. I'm at wit's end.    — Shannon B. (posted on March 29, 2004)

March 29, 2004
Shannon, My insurance (both of them) had air-tight exclusions for anything weight related - i.e., I could have been anorexic and dying, they still wouldn't have paid penny one for any treatment of any kind. I had five letters of medical necessity from various physicians and surgeons. My entire medical team believed I'd be dead from the effects of MO and the many co-morbidities that I had. We wrote letters to my husband's employer - they just pretty much didn't give a rip. We consulted with Walter Lindstrom, as well. It finally came down to recognizing that if I was going to have a chance at life, I'd have to self-pay. I went to Spain for my surgery - that was a little over 20 months ago. I've lost 205 lbs and virtually all of my co-morbidities. (I still have back and knee problems.) I'm pretty much as healthy as a horse. I am loving life like crazy! I am *so* thankful for the fact that my insurance DIDN'T cover WLS because I would never have found wonderful Dr. Baltasar and had this amazing wonderful BPD/DS! I would never have believed I'd be able to enjoy this kind of quality of life! Self-paying is much more affordable than you might think. For my surgery, travel to and from Spain - everything - my total costs were $15,800. That - and got one of the world's best bariatric surgeon's to boot! If you'd like to know more - you can see my profile, check out www.bodybybaltasar.com, or my profile on www.duodenalswitch.com. Hope that helps! dina
   — Dina McBride

March 29, 2004
Check your appeals process in the policy. You may be able to fight them at the State level. If youre allowed an external appeal keep appealing until you get to the State. Good luck Gary www.obesitylawyers.com
   — gary viscio