UHC says "not covered even if medically necessary"

[lynmar 23]

Hi all! I have a question about insurance policies purchased through your employer (UHC in particular). For the last 3 years I have been trying to get a policy that will cover surgery. I have researched, talked to people both at work and the insurance company, and made phone calls until I'm blue in the face. I even offered to get an additional policy and pay more for it so it would not cost my employer any more money.The policy that my agency has says that bariatric surgery is not covered even if medically necessary. I have a team of doctors who are behind me 100% and 2 even wrote great letters for me on why I would greatly benefit from this and what has been successful and unsuccessful for me in the past years.

The question I have is because surgery is excluded from my plan, would an appeal even be worth it? Has anyone ever done an appeal in this type of situation and had it change the outcome? Just want to know if there is anything I can do because I can not afford private pay up front which is what the hospital would require.

Any help or suggestions?

[FrankyG 1,450]

Not an expert, but I'm 99% sure that an appeal will do nothing if your insurance specifically has excluded weight loss surgery. Even if an insurance company would cover weight loss surgery in general, it has to be selected to be covered by your company, as they would need to have that coverage for all their employees (and pay the premiums - and depending on how many employees your company has, it could be tens of thousands a year, which is why many companies refuse to include it in their health insurance coverage).

You may need to start thinking about alternatives like having the surgery in Mexico or doing some intense saving for the next year or two to afford it here in the states.

[NikkiDoc 312]

I am a claims examiner and have been one for 25 years. If there is an exclusion in the Policy for bariatric surgery there is no point to appealing it.

[OutsideMatchInside 10,166]

If you live in illinois, buy a plan on health exchange.

[2goldengirl 2,076]

An exclusion from coverage is just that - an exclusion. Not covered, for anyone, under any circumstances. Don't waste your time with an appeal, explore alternatives, such as self pay in Mexico.