Question:
UHC written exclusion.....any fighting chance to appeal?

I have UHC epo,IL. and there is a written exclusion placed by my employer stating no benefits availible for surgical or nonsurgical treatment for obesity and morbid obesity. I put in an appeal on basis that exclusion does not state exclusion if medically necessary. I backed up with 5 letters from doctor stating medical necessity, records of $1.5million of past medical bills, and 200pages of medical notes. do i have a chance for appeal or is it a losing fight based on written exclusion.    — manalden55 (posted on May 15, 2003)

May 15, 2003
ABSOLUTELY, YES~~~ Morbid obesity is a health issue. Does you policy/employer say you are entitled to receive proper medical care without distrimination? To restrict a procedure based on discrimination for your morbid obesity should be fought~ For them to deny based on your morbid obesity is in essence denying you the right to longevity and quality of life and discriminatory against you based on your morbid obesity. DO NOT GIVE UP! If you believe you deserve this procedure then FIGHT. Take this to the next level, request an external appeal. Contact you local insurance commissioner. Contact your HR representatives and make sure they know how serious you are about taking care of yourself. MAKE WAVES as large as you can. You also have legal options if an appeal does not work. This can be won. I wish you success.
   — Diane K.

May 15, 2003
My employer has the same exclusion on our UHC policy. Sorry to tell you, but I lost 2 appeals very similar to yours. One thru UHC and one thru my company's HR group. I was finally told that it was covered under one of our optional plans "Aetna HMO". I had to wait for open enrollment and make the switch. This plan cost me an extra $3,000 a year for my family. But at least I'll be able to get the surgery. My Aetna HMO plan stated in Jan 2003 and I found out they have the "6 month - Dr. supervised diet and exercise program - within the last 2 years, "requirement. I should finish up on that in July and hope to have my surgery in Aug or Sept. Please pray for me - or at least cross your fingers. Tom
   — Tom Barton