Specifically Excluded by United PPO

February 14, 2005

Has anyone had United Healthcare PPO insurance where weight loss surgery is specifically excluded by the plan and then been approved? I don't know whether this exclusion in the policy is the absolute final answer or just to scare you off from trying. I don't want get my hopes up.

Also, has anyone in Dallas Texas had the surgery done in Mexico and had trouble finding a doctor to do fills around town? I certainly don't want to travel to Mexico each time $$.

Thanks for any info. I'm just starting out and have found this sight very helpful and inspiring.

GeezerSue · February 14, 2005

Just be sure to read the whole sentence...it might say, "...specifically excluded except in the event of..." Other than that, though, specifically excluded generally means your employer didn't want to pay for that benefit.

Well, wait a minute, does it say that the LapBand is specifically excluded or that wls in general is specifically excluded? There are cases where the band wasn't allowed but bypass WAS, and the doctor wrote letters and it WAS paid for. So, can you be more specific on EXACTLY what the policy says?

February 14, 2005

It just says it excludes "surgical and non-surgical treatment of obesity, including morbid obesity." I'm assuming that means even with complications related to obesity and would exclude lapband, gastric bypass, etc. Does this mean it's hopeless?

Sharon T - PA · February 14, 2005

But if it's excluded, then I would think it's unlikely that you will get a break...

My previous employer had the same exclusion - and we never went around it.

Sorry to be the bearer of bad news...but I would still check with your employer, especially if you are self insured.

Good luck.

New Hope · February 14, 2005

Sure can't hurt to check with your benefits coordinator.

BeachBabe(soon) · February 22, 2005

I have UHC also. I called them again, 5th time, they always said the same thing. "NO...exclusion! Your employer did not chose to have this." Today the "nice" girl said the same thing, but...............she also said " Go to whoever can write you a better letter of why you need this surgery as in "medicaly nessesery". I asked her to tell me honestly if I have a chance and she a "very good one". So I'm going to make a appt. with a surgeon under my plan and see what happens. Got my fingers crossed. I'll let you know what happens.

Tina