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 Any expert advice on one person health insurance for the self-employed?
I have no idea where to start looking for health insurance for the self-employed. Any advice??...


 How do I get my ring valued?
I'm wondering whether I should get my engagement ring insured. Does anyone know how I can get a reliable valuation?...


 Are these health insurance ads I'm seeing on TV for real?
I have open enrollment at my job for next year but I pay $500 a month for family coverage. Can I do it cheaper without compromising my families care?...


 Which are the best life insurance companies'?
name four A plus....


 Need some help here guys...?
ok so im looking for a health insurance i can pay monthly without optical included. i need medical and dental...dont want to spend more than like 200 dollars a month...help me out guys...anything? ...


 I have a life insurance exam and I smoked a few cigarettes...?
I quit smoking a few years ago but I recently lost my mother and have smoked a few cigarettes (like 6 cigarettes over the last 2 weeks). I have to take a blood test for for a new life insurance ...


 Is there anybody who can give me guidelines on making life insurance advisors?
I need Insurance advisors,how can i make life insurance advisors?...


 Do I really have to disclose everything for a life insurance quote??
My wife has a family history of cancer which is causing my life insurance quote to change from £15 a month to £50. Do I really need to disclose this info to the companies, or should I not tell them ...


 Can your family cash your life insurance policy if you're killed in a crash & test positve for drugs/ alcohol?
...


 Does anyone have term life insurance with primerica? Are rates with another company better?
...


 I have lost my national insurance card and i do not know the number,
i need it for an interview quick what can i do?...


 What could I do if a company keep sending billing statements that were not my responsibility?
I have done an x-ray in a lab a year ago. The lab failed to submit the claim to the insurance company soon enough. As a result, the insurance company refused to pay the claim. Then, the lab sent the ...


 In the case of an insurance, what does $100 deductible mean?
this is a question from a test. i'm sure a lot of you guys know what it is....HELP!!
Additional Details
a. $100 is deducted from your insurance premium each year.

b. your ...


 Furnace needs replacing, will homeowner's insurance cover it?
My mother in law's furnace went out the coldest day of the year, will homeowner's insurance cover the 3200$ + it will cost to replace it? State Farm is the insurer....


 Medical Claims being denied - How to prove I had insurance?
I went in for an outpatient surgery last month. I have very good insurance and the co-pay should have been $200.00. Instead I get a letter from the hospital telling me that my insurance company ...


 I live in South East London and wondered if I have to have terrorism insurance to get a mortgage for my flat?
I have been told that some mortgage companies will not give mortgages without the property being insured for terrorism despite the fact we live in se26 in a small block of 12 flats and wondered if ...


 How do I spend $700 from my medical expense account FAST!!?
We are a family of 3
Additional Details
no ...


 How much does homeowners insurance cost for a 250,000 house?
...


 They didn't make me pay in the emergency room but I know I have copay?
Will I just get a bill in the mail? I'm positive I have to pay something but the clerk said it doesn't say on my insurance card....


 In my divorce it states i must provide medical insurance for my daughter, do I have to use my employers insur?
I need to know if i must use my employers insurance or can i get my own policy somewhere else for her only. It is very expensive through my work and really the coverage isnt that great....



TAZZLOVER8
Is there anyway to get around exclusions in your insurance policy?
I have United Healthcare and my particular policy excludes any surgery for obesity. I was hoping to have the bypass done, but since it is excluded.... I would have to pay for it out of pocket, and I cant afford that. I barely make enough to make my bills, none the less add a surgery. Can anyone tell me if they make exceptions to exclusions? Or is there a way to get around them? I really need this surgery if I want to be alive in another 10-15 years. I am submitting a letter of medical necessity from my doctor and a bariatric surgeon. I am can show a family history of comorbidities. I dont have any comobidites yet, but I will soon. My a1c is on the high end of normal. And my cholesterol is normal... but my ldl is on the high end of normal. I am getting a sleep study done to prove I have sleep apnea... but I dont know what else I can do. Any suggestions?

And in advance to those that will say go on a diet... I have been on dr supervised diets with no sucess.
Additional Details
I also know for a fact that they do cover this procedure on other policies. I have a friend who has UHC that had it done a year ago in March. Her coverage did not exclude it. So I know they do cover it if you have a certain policy. However, when I spoke with the guy who sold our company the insurance, he explained to me that exclusions are chosen by the company that buys the policy... which would be my employer. And while they were trying to keep down costs, they excluded it because since I work at a gym everyone else, besides me, is thin. So they never expected to have to use it... so why pay for coverage that they will never need? And while I understand that.. it is too late to change the policy... because then it would be a preexsisting condition... and still not covered.
                     
 




mbrcatz
For the most part, no, a flat out exclusion won't be covered. You can appeal it, and you're doing the right stuff - with the letter of medical necessity from two physicians. So if there's ANY chance they'll do it, that's what you need to do - AND, include a letter from the doctor who supervised the diets, too.

But the problem is, there are some procedures that insurance companies just haven't factored into their rates - and that's one of them. And if they make exceptions for exclusions for one person, then legally a court will make them make exceptions for EVERYONE, and poof, there goes the exclusion. And the rates triple for everyone.

If you really think you only have 10 years left without this surgery, well, if it was me, I'd jump through hoops to find an alternative to the surgery that could lead to weight loss.


acermill
No, you will not get around this exclusion. The insurance company has the exclusion for such coverage in order to keep premium costs lower. The fact that you may truly need this surgery medically will not override their exclusion. By the way United Healthcare is far from the only one including such an exclusion. Gastric bypass surgery is an expensive procedure. Even those insurers which will cover it will require that you use other means to attempt weight loss for a lengthy period before they will pay for the procedure.


Jifr
Hiya:

I believe this is going to end up being a covered surgery (at physician's direction) down the road.

Why?

It ultimately saves them money! The chances that you are going to need blood pressure medication, diabetes medication and supplies and other obesity related items will go down SIGNIFICANTLY over the period of your life if you have the surgery and successfully maintain a healthy weight. The information out there already proves that.

I think you have all the information you need. I know for a fact that they can and have covered this surgery. If they deny you the first time you can make an appeal with all of your information.

They may, and rightfully so, approve OTHER weight loss options to exhaust other available treatments before they would authorize the surgery - but like I said - they can and HAVE approved it before.

If they do NOT approve you - you may have legal recourse against them for failing to authorize a life saving surgery as prescribed by your treating physician especially in light of the fact that they have approved it in the past.

Goodluck to you!

~jifr!


mamatohaley+1
It is my understanding that exclusions are just that and are not negotiable. If they negotiate for you on this, then their entire policy and exclusions would have to be negotiated for everyone.


don1862
Rating
Maybe if you can prove they defrauded you oe misled you about the exclusion, but you definitely need an attorney to do it.


stephenweinstein
Rating
1. Try to get diagnosed with "morbid obesity". They may consider this to be a different condition from regular "obesity".
2. Get a different insurance policy, one without this exclusion.


Mr. Prefect
I doubt if you are going to find companies with exclusions. They all tend to do more or less the same thing.


Brandi F
Rating
Apply for county assistance. Most people can quailfy for some variation of either medicaid or county insurance-if your county offers it. That will help just incase UHC doesnt budge-which the chances of that happening are slim. Keep trying though because you are doing all the right steps. Also, call the insurance company and ask if your doctor can do a peer-to-peer review with their medical director. It may help.


~♠♥CJ♥♠~
Rating
They probably won't cover it, but you can try. Just get your doctor to request for authorization. After they deny it, make an appeal (in writing, do not do it over the phone) and submit all your documentation showing medical necessity.


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