Well... I just got off the phone w/ my insurance company (UHC). Of course, the policy that my employer bought does NOT cover any sort of weightloss procedures/plans (surgical and non-surgical). The Customer Care Rep told me to write an appeal letter and that I would have an answer from UHC within 30 days of them receiving my letter. Has anyone else had to write an appeal letter to UHC? If so, what was their decision for you? What type of info did you include in your appeal letter? Did you have your dr. write an appeal letter as well? THANKS!

Well... I just got off the phone w/ my insurance company (UHC). Of course, the policy that my employer bought does NOT cover any sort of weightloss procedures/plans (surgical and non-surgical). The Customer Care Rep told me to write an appeal letter and that I would have an answer from UHC within 30 days of them receiving my letter. Has anyone else had to write an appeal letter to UHC? If so, what was their decision for you? What type of info did you include in your appeal letter? Did you have your dr. write an appeal letter as well? THANKS!

Usually if the employer does not cover WLS there is usually no option for an appeal.

As you know there are always an exception to any rule :smile2:.

The exception to this rule would be that usually when a group is self insured through an insurance company. The employer can adjust the benefits as they want see fit as its their money.

When a group is self insured, it usally means they are using their own company money but the insurance companies administers the benefits & pays the claim out of the employers money.

Hope this helps, Crystal

Your surgeon's front office people should have a sample appeal letter you can use. Ask. however, I would think that some documentation or a letter from your primary physician statint the duration of your weight problems, discuss your co-morbidities, etc. would be what you need as part of your appeal. Just don't hold your breath. A "specific exclusion", i.e., your policy has a paragraph that says it will not cover any weight loss care or weight loss surgery, will be hard to get around. GOOD LUCK!

I have worked for several years in insurance and healthcare and some key words to use in any appeal situation are - quality of living/life (very important) and mental or emotional strain/anguish. No guarantees but do mention those as strongly and enough times to get your point accrossed. Hope that helps you in your journey. Good Luck !

THANKS!!! I appreciate the advice:)