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Denied do to Exclusion? Is there a way to Appeal?

Denied do to Exclusion? Is there a way to Appeal?

Postby JDubbs » Mon May 24, 2010 4:41 am

I have insurance through United Health Care. I was referred by my Family Doctor as well as my Endocrinologist and Pain Doctor, To have Gastric Bypass Surgery, "As a Medical Necessity" (My health is Poor at best!) I did everything they said my insurance company requires. Then when it came time for them to Schedule the surgery, They came back saying that I was Denied do to exclusion! When I asked the doctor if we could appeal it? They told me it was now in my hands to do what I felt was necessary! That when they receive a denial for exclusion they are done and could not help me further. So has anyone had UHC and been denied for Exclusion? Were you able to Appealed it? And did you WiN? Can it be WON? Can anyone point me in the right direction to what my next steps should be? Maybe Someone has some pointers on how to beat this Crap!!


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Joined: Fri May 21, 2010 10:08 pm

Re: Denied do to Exclusion? Is there a way to Appeal?

Postby MichC » Thu Jul 08, 2010 1:00 pm

I have United HealthCare and was denied due to an Exclusion for a "medically necessary" Breast Reduction. I appealed first to UHC Appeals Dept and then to the state. Was still denied. The next step would have been going to court to fight it which would have involved lawyers fee's and alot of time. I paid the $6800 out of my own pocket and I'm thrilled. Best decision I ever made.

Godd Luck to you.
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Joined: Fri Aug 21, 2009 12:43 pm

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