UHC Denying Lap-band Adjustments!!!

[msdont 0]

I've been banded since 2003, prior to joining UHC. I recently had to go in for several adjustments. To later find out they they are not covered under my medical plan. My plan simply states that there is no coverage for Morbid Obesity. I didn't think that the adjustments would fall under surgery. What are my chances for having an appeal overturned? Is it even worth appealing?

[MacMadame 81]

Some surgeon's offices code them as simple office visits. Has yours tried that?

[msdont 0]

I'm not quite sure. I do know that the office visit portion of the claim is being processed to pay, though. My surgeon has written a letter on my behalf, so I've submitted that to them. I'll be waiting. Thanks for replying.

[tiggerfan0464 0]

I have UHC as well and my drs office went out of network in July. I have what is call Gap Exception and now my fills are covered. First call your drs office and get the codes they bill to the insurance company. then call UHC and ask for a Care Coordinator and ask about Gap Exception. You will need the code for morbid obesity and the coded for the fills.

Good luck,

Kathy