Unicare

I am just beginning in my journey to get my surgery approved with my isurance company.  I found out that Unicare is saying that they are not going to approve it if I submit it.  I know that people have fought their insurance companies and gotten it approved.  However, has anyone out there had any success with Unicare?  They are not very common out there from what i have found so far.  Please someone give me something encouraging!

Why are they saying they are not going to approve it???  I dont have Unicare, but I bet we could be of more help if we knew what their issue was.

Well, they are saying that there is an exclusion on my policy.  But when I read the exclusion it sounds to me like they wont pay unless it is a serious medical necessity.  You know how those companies word stuff in the most confusing ways possible.  But the bottom line is that they did not even ask if it was medically necessary, they just said that they wouldn't do it.  I am going to try to get an appointment with a doctor that a friend of mine got her procedure done by.  She said that she had an exclusion on her policy and this doctors office helped her in fighting their denials and they finally approved her.  But she did not have Unicare, so I was hoping that someone out there had actually been approved through them.  You know, to boost my spirits a little.

Hmmm, I think an exclusion is not easy to overcome but it may be possible.  Talking to the surgeons insurance person may help provide insight.  I hope you are on the right track.  Maybe someone with more experience will chime in.  Good luck - D2K

Hi Lanette, Well, I don't have anything encouraging to tell you about UniCare... yet. But I have, too,  heard of insurance companies paying for WLS after several letters, different medical coding, etc...  I also have Unicare (PPO Platinum) and while I have not even gotten as far as to submitting a preauthorization request, I read the section in my policy that states that they do not cover any type of WLS.  Of course insurance never wants to pay for anything, and I am hoping that my Dr. here in Dallas will find a way to get it through one way or another. If I do have any success with UniCare, I will certainly share any info I get with you and please do the same for me.  Good luck! Darcy

Well, it is nice to see that there is at least one other person with my same type of insurance.  I will keep you updated about any new develmentsopments