Anyone have UHC POS Plan?

kittylover · August 13, 2006

Hello, I had my consultation on Friday and I was denied by my insurance. I have HUC POS plan. I have many problems caused by obesity and I called UHC to see what I can do. The woman I spoke to said I can send them a bunch of information about my problems so they can determine if it's medically necessary. So far I have about 5 different doctors I can get records from. Wish me luck, I am super depressed about this. When I found out I wasn't accepted and had no one who would finance for me I came home and cried while eating a cheeseburger lol. Thanks for the support, you guys are the best. :faint:

Mvpo8961 · August 13, 2006

kittylover I'm a little confused. Did you have your consult with a bariatric surgeon? Have they submitted a letter of predetermination to UHC? Who told you you were denied? Are you sure your policy doesn't have an EXCLUSION for weightloss surgery?

Give us a little more info about your situation.

A true denial should be accompanied by a letter for UHC giving the reasons why. Then you can appeal that decision.

However if your policy has an exclusion then there usually is very little to be done.

There is a big difference between denial and exclusion.

Myra

avilla · August 13, 2006

I have UHC HMO and they approved me the first time around...I only had to have over a 40 BMI and was automatically approved without any documentation of any medical history

kittylover · August 13, 2006

I never went to see the surgeon but I went in to talk to the woman from the hospital where it is done, who sets the process up. They called to see if I was able to be covered by my insurance and they said I was excluded but I can send in paperwork from my doctors and their staff of nurses will see if it's medically necessary.

Mvpo8961 · August 13, 2006

kittylover it sounds to me like the first thing you need to do is call UHC yourself and see if there is an exclusion on your policy. Employers are able to pick and choose what they want to cover when they set up with the insurance plan with UHC.

When you enrolled in your insurance you should have been given a summary plan description. In my case it is a booklet about a 1/2 inch thick that tells me what all is and isn't covered with my plan.

If you don't have a SPD you can request one from your human resource person. You also can ask them about an exclusion but know that they aren't always up to speed on what is and isn't covered.

Also you can call UHC directly and ask them if lapband is a covered procedure and what are the criteria for coverage. Such as a six month physician supervised weight loss plan. Know that you will be talking to a service rep and be persistent to get answers. Ask for a copy of their policy to be sent to you in writing.

After you see your bariatric surgeon they will submit a letter with documentation to the insurance company if you don't have an out and out exclusion. Then it is a waiting game. Read some of the other posts on here. Do a search for UHC and you will find lots of info.

Don't give up yet it sounds like you still have lots of info that needs to be addressed.

Kittylover look at the my screaming in frustration thread and you will get an idea how difficult UHC can be. I just bumped it for you so you should see it when you refresh your page.

Myra

kittylover · August 13, 2006

Thanks Myra, I will have to look around for my fiance's book of benefits. I have found all the numbers of the 6 places/doctors I need to contact so hopefully I can get the info back soon. Thanks for the support, I am indeed screaming in frustration too. I will read your post, thank you