Re: UHC says I have an EXCLUSION

[Guest guest]

If there is an exclusion for " obesity " this does not mean they can get away

with denying for " morbid obesity " . They are two separate conditions.

Dawn--Chicago metro--south

Dr. Hess, Bowling Green, OH

BPD/DS

www.duodenalswitch.com

267 to 165 5'4 "

size 22 to size 10

have made size goal, weight goal may need to be adjusted.

no more high blood pressure, sore feet, or dieting!

[Guest guest]

In a message dated 7/25/01 9:31:31 AM Central Daylight Time,

mortonj@... writes:

<< Does any

one know of anyone eho has been approved for any wls through

BellSouth? I was expecting a fight over the DS

being experimental but not total denial. >>

I have Blue Cross Blue Shield of Ala thru BellSouth and they did approve the

RNY gastric bypass but not the DS. We have a choice each Fall of which

insurance we want-- either BCBS PPO or United Healthcare HMO, I have always

chosen BCBS because I don't like HMO's. I wondered if UHC covered the DS. I

am glad now that I didn't choose them. I am in Mississippi. I don't know if

in your state BellSouth gives you a choice of companies but if they do, you

might want to switch this Fall to BCBS. At least you can get the RNY, which

is what I have decided to do.

Good Luck!

Cindy W in MS

[Guest guest]

,

First insist on a copy of the insurance contract so that you can read

the list of exclusions for yourself. They might be BSing you (it has

been known to happen - a clearical error you know). Did you get the

name of these 3 people who told you that it was only necessary to

prove medical necessity. Do you have any major comorbidites? Is

Bellsouth using UHC only as a TPA or is your company fully insured.

If it is the former, you can appeal to your company.

Good Luck,

Hull

> I haven't posted much here but I am trying to get approval for one

> form of wls or another for 3 years now. I gave up on Kiaser

Permante

> and switched to United Health Care in January specifically because

of

> this surgery. I asked the plan representitives on thre different

> occasions if there were any exclusions that would stop me from

being

> approved (as there were with Kaiser) and I was assured that there

> were none. Well here I am 7 months later and finally have gone

> throughthe hoops and had the consultation, finally got the LOMN

sent

> in and BOOM, I heard from UnitedHealth Care today

> that I am being denied because BellSouth has an exclusion in its

> coverage for ANY Obesity related surgery. This is not a DS verses

> RNY issue. I would be denied for simple stomach stapeling. Does

any

> one know of anyone eho has been approved for any wls through

> BellSouth? I was expecting a fight over the DS

> being experimental but not total denial. I am blown away. It is

> Kiaser Permante all over again. I am no further than I was 3 years

> ago. I called three different times to the BellSouth Customer

> Service center for UnitedHealth Care and asked them specifically if

> their were any exclusions for this surgery and was told 3 times by

> three different people no there were no exclusions and only medical

> necessity had to be shown. I don't know what to do now. I can

appeal

> with UHC that will do no good, because they are not going to pay if

> they don't have to, I am calling the Director of Benifets to ask

> about this but she is out of town until Monday. I can't tell you

how

> mad and disappointed I am over this, after being told 3 times and

> switching insurance companies specifically to get this surgery. If

> any one knows any one from BellSouth that has been approved for any

> wls especially through United Health Care please let me know.

>

>

[Guest guest]

In a message dated 7/25/01 5:14:53 PM Central Daylight Time,

mortonj@... writes:

<< I don't see how UHC, who approves WLS of all kinds all day long for

policies other than BellSouth, can have a BellSouth Exclusion and

BC/BS of Ala not have the same exclusion? >>

I don't know but I called the Human Resources office of Bellsouth in Atlanta

and tried to get them to intervene. They very nicely told me that they have

nothing to do with it.; that they pay BCBS of Ala to administer all claims

and they cannot get involved. They told me to appeal it if I was denied. I

told them I did that, but they were of no help, whatsoever.

Cindy W in MS

[Guest guest]

> ,

>

> First insist on a copy of the insurance contract so that you can

read

> the list of exclusions for yourself. They might be BSing you (it

has

> been known to happen - a clearical error you know).

I have asked that they fax me the pages that they are referring to ,

and haven't gotten them yet. I will ask for the full contract also.

> Did you get the

> name of these 3 people who told you that it was only necessary to

> prove medical necessity.

No, I should have but they were the BellSouth " dedicated help line "

during open enrollment. I wish I had gotten them.

> Do you have any major comorbidites?

Yes definatntly, Very Severe Diabetes (300 units/day of insulin + 3

meds) Sleep Apnea, Atril Fibriliation, High BP

> Is Bellsouth using UHC only as a TPA or is your company fully

insured.

I think BellSouth is self insured, and they manage it, but I am not

sure.

> If it is the former, you can appeal to your company.

>

> Good Luck,

>

> Hull

Thanks for the advice I appreciate it.

[Guest guest]

Thanks Cindy,

I don't see how UHC, who approves WLS of all kinds all day long for

policies other than BellSouth, can have a BellSouth Exclusion and

BC/BS of Ala not have the same exclusion? Does anyone know if they

can do this?

> I have Blue Cross Blue Shield of Ala thru BellSouth and they did

approve the

> RNY gastric bypass but not the DS. We have a choice each Fall of

which

> insurance we want-- either BCBS PPO or United Healthcare HMO, I

have always

> chosen BCBS because I don't like HMO's. I wondered if UHC covered

the DS. I

> am glad now that I didn't choose them. I am in Mississippi. I

don't know if

> in your state BellSouth gives you a choice of companies but if they

do, you

> might want to switch this Fall to BCBS. At least you can get the

RNY, which

> is what I have decided to do.

>

> Good Luck!

>

> Cindy W in MS

[Guest guest]

Bell South, like other large corporations is self-insured. Their

healthplans are administered by UHC or other large insurance companies.

However, the coverage is based on what BS has authorized and is exclusive to

their plan. Although, other people around the country may get approval

using the same insurance administrator (like UHC or Aetna or BC/BS), if BS

has an exclusion you have to appeal to their benefit committee and

acceptance is controlled by Bell South.

It stinks!

Kathie

Re: Re: UHC says I have an " EXCLUSION "

> In a message dated 7/25/01 5:14:53 PM Central Daylight Time,

> mortonj@... writes:

>

> << I don't see how UHC, who approves WLS of all kinds all day long for

> policies other than BellSouth, can have a BellSouth Exclusion and

> BC/BS of Ala not have the same exclusion? >>

>

> I don't know but I called the Human Resources office of Bellsouth in

Atlanta

> and tried to get them to intervene. They very nicely told me that they

have

> nothing to do with it.; that they pay BCBS of Ala to administer all claims

> and they cannot get involved. They told me to appeal it if I was denied.

I

> told them I did that, but they were of no help, whatsoever.

>

> Cindy W in MS

>

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>