Question:
I have UHC-HMO Choice, WLS is a diect exclusion...

Do I fight this? Do I even have a chance? In 8 weeks I will have BCBS of Minnesota which will be a PPO, and I'll need a prior-authorization. Shoul I just wait 2 months for this insurance or should I try with UHC? The surgeons office staff said I'll get rejected.    — Shannon D. (posted on April 11, 2003)

April 10, 2003
Hi, I have UHC and mine did pay for my surgery but my exclusion stated EXCEPT for medical necessity. If you have a direct exclusion without those words, it is highly unlikely that they will approve you. I would wait and go with the other insurance. I have read on here that even Walter Lindstrom the obesity lawyer, has had very limited sucess with these exclusions and usually will not even take the case it is so hopeless.
   — Delores S.

April 10, 2003
I had UHC with an exclusion for obesity and morbid obesity. I tried to fight, appealing twice on the basis that I was Super Morbidly Obese, they didn't care. I am now self paying. I would wait it out if I were you because UHC won't budge! Good luck to you!
   — SMG I.

April 11, 2003
i have the same situation. from my understanding. the exclusion is placed by your employer and not neccessarily UHC. is this correct? if this is true, i am currently working to appeal. but my question is, would it make a difference if i had my employer see that i need this medically and they themselves agree to cover. would UHC cover it then?
   — manalden55

April 11, 2003
If your employer is self insured and just uses UHC to administer the plan, you may have some luck with appealing to your employer. If they aren't self insured, but put that exclusion in when they contracted with UHC, you might try to convince them that the exclusion should be removed the next time they sign a new contract.
   — garw

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