DS excluded but GB not-can i get ins help?

[Muggyruggy]

I was referred here to ask for help because my United Healthcare Ins policy covers Gastric Bypass and Sleeve surgeries but EXCLUDES Duodenal Switch.
*** someone said if they cover one weight loss surgery they should have to cover them all?
Is there any help on here for me with a possible appeal for this? I haven't been denied yet

 

[DianaCox]

Yes - but you can first check things out.

1. Please post a link to the policy
2. Has your surgeon submitted the request for preauthorization yet?
3. You can't appeal until you get a denial - maybe call UHC and ask why DS is not covered, when it is a standard of care surgery per ASMBS and Medicare? https://www.cms.gov/medicare-covera...,F,P&contractOption=all&sortBy=relevance&bc=1

 

[Muggyruggy]

Policy is posted in the below posts. It says:

 

[DianaCox]

Yes, it’s worth it. Have won many appeals like this.
Please ask your HR department for a pdf copy of your Evidence of Coverage - it’s your full insurance contract, should be about 100 pages long, NOT the summary of benefits. And find out if your plan is fully-funded or self-funded - different laws apply.

 

[Muggyruggy]

The policy is FULLY FUNDED......If I have to upload the document in multiple documents is that ok? It's too large.....

 

[southernlady]

Welcome Muggyruggy
I told you on FB, you could get help here.

 

[Muggyruggy]

Welcome Muggyruggy
I told you on FB, you could get help here.

Thank you!

 

[Muggyruggy]

. MY POLICY IS ...FULLY FUNDED.......

 

[Muggyruggy]

Not sure why it won't let me upload files

 

[Muggyruggy]

Ok here is an attempt to provide a link to all the documents to my policy.
https://1drv.ms/f/s!Au6A1dSZ3C-6gTTDU7g24HP-ptgR
Here are the documents with the page numbers listed:
Last 4 digits of document name:
8951 - pg 1-20
7329 - pg 21-40
8786 - pg 41-60
3323 - pg 61-80
1004 - pg 81-100
5056 - pg 101-120
4763 - pg 121-140
7939 - pg 141-161

Policy is fully funded

 

[Muggyruggy]

Also...I will be a Revision Sleeve to DS...and I am in the very first stages of fulfilling requirements but like I said, my policy excludes DS and my BMI is 42

 

[Muggyruggy]

DianaCox
Larra

 

[Muggyruggy]

Well nevermind the request for help...they got me...UHC That is. I got a list of surgeons today that was Optum COE certified which are required for me to choose one and none of them even do the DS Surgery! So I'm stuck with getting gastric bypass. Thank you ladies anyway.

 

[southernlady]

Well nevermind the request for help...they got me...UHC That is. I got a list of surgeons today that was Optum COE certified which are required for me to choose one and none of them even do the DS Surgery! So I'm stuck with getting gastric bypass. Thank you ladies anyway.

You can still fight this and be seen by a DS surgeo.

 

[Muggyruggy]

How would I do this if the surgeon I have to see MUST be an OPTUM Center of Excellence certified surgeon? They gave me the 3 most closest to me that were certified and none of them do DS.