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How Do I Get Around This?

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Hey All,

My insurance (United Healthcare) just called and said that we got

ahead and overlooked something.

Now they denied me because I would be going out of

network and I have out of network benefits, but excluding morbid

obesity. Basically, I can have surgery, but I need to stay in

network. I said give me the # of a surgeon doing the DS in network.

She said they don't have one in-network which was the only reason I

was going out of network. I talked about inadequate coverage and she

said that won't work because they allow me to get the RNY in

network. I don't want the RNY. I know people have gotten around

this, but I need to know how. Please help or direct me somewhere for

help!

Thanks So Much, Tyner

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Gosh all of this UHC stuff!! I hate them for the trouble they give

people.. look at your certificate of coverage. .dont just take their

word for it.. you should have gotten a book that gives all the

details.. My hand book says on page 20, section 9 titled " Referral

Health Services Rendered by Non-Participating Providers. In the even

that specific Health services cannot be provided by or through a

Particiapating provider, you are eligible for Coverage of Eligible

Expenses for Medically Necessary Health Services obtained through

non-Participating providers. " Check yours to see if this is there..

if it is.. your home free. I'll give you a copy of my approval for

100% paid as in network that was out of network because there is no DS

surgeon in network.

> Hey All,

> My insurance (United Healthcare) just called and said that we got

> ahead and overlooked something.

> Now they denied me because I would be going out of

> network and I have out of network benefits, but excluding morbid

> obesity. Basically, I can have surgery, but I need to stay in

> network. I said give me the # of a surgeon doing the DS in network.

> She said they don't have one in-network which was the only reason I

> was going out of network. I talked about inadequate coverage and

she

> said that won't work because they allow me to get the RNY in

> network. I don't want the RNY. I know people have gotten around

> this, but I need to know how. Please help or direct me somewhere

for

> help!

> Thanks So Much, Tyner

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