United Health Care with exclusion

[Guest guest]

I am preop and am fighting the insurance demon. My company is self

insured and use United Health Care. They have an iron clad exclusion

that will not permit weight loss surgery at all, bottom line. Well,

one of the gals that I work with had the lap band. Her husband's

surgery was going to cover the surgery after UHC denied the

coverage. She had her surgery in February. As the bills started

coming in, UHC started paying for them. They paid the pre-surgery

testing. She told me that and we just figured that it slipped by.

Then she told me that they paid the total hospital bill, the doctor

bill and even several of her fills!! She has called them, told them

that they covered a procedure that is an exclusion in our policy.

The customer service person acknowleded the exclusion, but said that

it was sent through. Has this happened to any of you?? I am so

confused. She does not want to say anything because she is not out

any money because her husband's insurance will pick up anything UHC

will not pay. In the past 2 years, I have approached my HR

department to get out policy changed. Does anyone know how long my

coworker would have to wait before UHC could not come back and

reverse the payments that they have already paid?

Sorry this was so long. Thanks for any information you can offer.