Question:
prior approval vs. exclusion

I spoke with customer service at United Health Care on numerous occasions. One day they tell me the RNY is an exclusion to the policy, and the next day they tell me you need prior approval. I noticed under "research insurers" United Health Care seems to be paying for the most part, provided it is medically necessary. What is the latest on United Health Care?    — gina K. (posted on January 25, 2002)

January 25, 2002
Have someone at your PCP's office call and talk to someone in prior approval.. they should be able to tell them whether or not it is something they cover.
   — Elizabeth D.

July 29, 2002
I also have UHC and I spoke to them today as a matter of fact. They told me that as long as the surgery was deemed "medically necessary" then it would be covered. I tried to get a definition of "Medically necessary" but all I got was a general answer. One good thing is, I asked them if I needed a referral from my PCP and they told me that I was able to "self refer" to a surgeon and didn't need a paper referral from my PCP. So I am going to assume (I know, I know) that as long as my surgeon deems it "medically necessary" then they will cover it.
   — Melissa M.

July 29, 2002
GINA: Whether the surgery will be covered depends on other factors than medical necessity. I was denied coverage because the policy AGREED TO BY MY EMPLOYER specifically excluded all forms of weight loss therapy, including medical treatment, counseling, surgery, you name it. Check with your employer's benefits representative to be sure.
   — Marjorie B.

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