UHC says I have an EXCLUSION

July 25, 2001

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.

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