Question:
ANYONE DENIED A REVISION WITH A UHC POLICY EXCLUSION...

and then won subsequent approval. I need help! My policy has an exclusion for WLS. However, UHC is saying this surgery can be covered if medically necessary. They are not seeing the dilation of my pouch as medically necessary. All I get from them is a letter saying it's an exclusion and not based on medical review. I am trying to argue the point that this is a revision of surgical treatment for obesity and not a request for initial surgery. I am also arguing (to no avail) that there is no specific policy language that supports ther denial of my revision. I have contacted the Attorney General's office, the insurance commissioner and I am now writing letters to state legislatures. I am desperate to have this revision. Any and all suggestions would be appreciated.    — Sandra C. (posted on December 1, 2004)

December 2, 2004
I'm kind of confused. Are you seeking a dilation or a revision? They are two totally different things. If it is a dilation because of a stricture, your surgeon should use the correct procedural code. A revision is when they make the pouch smaller, do more intestinal bypass, convert to a DS or RNY.. what are you looking to do?
   — SarahC

December 2, 2004
Sarah, I will be getting a revision. My pouch has to be made smaller.
   — Sandra C.

December 17, 2004
I am appealling based on something similar. H pylor has caused staple line disruption. In order to repair it my physician has requested a bypass. Well I am already bypassed. They would repair an ulcer if need be right. Let me know how your quest goes. Tina
   — cruise queen

June 27, 2006
UHC has completely denied my request for a revision. I have a staple line disruption for a RNY done 9/2001. I have gained most of my weight back. UHC has told me the same thing you are being told and I even hired the WLS attorneys for $850 to file the appeals for me and threaten to go to court. UHC has held firm that they will not cover this. It has been over two years now and I am ready to head to Mexico and get the lapband to fix my issue.
   — tberryhill

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