Anyone had to use UHC "member appeals"?

[sue_vici0us 0]

Hi there. I'm brand new. I'm feeling really horrible and helpless at the moment. From everything I've read online, UHC is normally good about covering weight loss surgery. However, I called and my specific plan does NOT cover it; in fact it is specifically written in that they don't. I'm pretty upset. I shouldn't have gotten my hopes up. I'm really afraid of what's going to happen to me if I can't get this surgery done.

I'm asking for help with a couple of things. First off, if you know of any alternatives to insurance, please let me know.

Also, my insurance company gave me a PO Box for "member appeals", and said I could send in documentation to support the fact that I NEED this surgery, and they could POSSIBLY cover it. Has anyone had to do this before, and did you have any luck?

Thank you so much.

[deemarie 0]

I Have UHC-EPO. I too was frustrated because my plan stated it did not cover gastric surgery. But then, I received by 2008-2009 Benefit Options Plan Description book in the mail and it stated under Article 9 Exclusions and general limitations that :

"Medical and surgical services intended primarily for treatment or control of obesity which are not Medically Appropriate. Services for the purpose of diet control and weight identified condition of disease etiology. Services included but not limited to: gastric surgery, intra oral wiring, gastric balloons, stomach stapling, jejunal bypass, dietary formulae, hypnosis, cosmetics, and health and beauty aids are not covered unless all the following items are met: Documentation of 5 years history of severe obesity

With a year immediately preceding the planned surgery documentation of 6 consecutive months participation in physician-supervised weight loss program...Must include all of the following"

· Psychiatric assessment and approval

· Medical assessment and approval

· Nutritional Counseling

· Exercise Counseling

· Psychological Counseling

· Support Group Meeting

My personal doctor wasn't very helpful at first. I told him up front I was interested in Lap Band. I had been going to him for a year. He suggested calorie counting and exercise. I would lose only to gain it back when company visited or vacation time etc. I finally got depressed, mad, you name it. He read my insurance book and wasn't sure Lap Band surgery was covered by my UHC policy. He gave me a name of a surgeon out of town. They are working with me to meet the insurance requirements prior to submitting the claims. The necessary tests are covered by my insurance because they are submitted as diagnosing and treatment for "GERD" and acid reflux.

Sorry this post was so lengthy but I hope it helps. I have my first appointment on July 27 to see the Bariatrician, Dietician, and to have a GI study (Manometry Study). I live in the Phoenix area and am traveling to Flagstaff (2.42hrs away) to start the program. I made the above appointments so there is less time from work. I will travel to Flagstaff once a month for the next 6 mos. to get this done!