Insurance changes after banding - lots of uncertainty

Katy517 · June 14, 2010

I was banded this year under my partner's insurance plan as a dependent. That insurance coverage option will no longer be available to me as of Jan. 2011 so I'll be opting back into my employer's medical coverage. I have two options under that plan - United Health Care PPO or UHC EPO. From what I understand both specifically exclude WLS. I've read conflicting information here though concerning what UHC covers.

I've confirmed that my lap band surgeon is not included in either network. Am wondering whether post-surgical fills or follow-up visits will be included? There is no preexisting condition clause so that's not an issue. What I'm especially unclear on is whether the WLS exclusion would also exclude related post-op care. It looks like I should choose the PPO option if I want any portion of visits with my lap band surgeon to be covered at all.

Also have an ongoing issue with my port. I'm two months post-op tomorrow and my port is still a constant irritant to me and painful doing almost anything that works my abdomen including bending over, sitting up, etc. It also looks and feels like a large tumor. My surgeon keeps tells me to wait it out and thinks it will get better and be less problematic once I lost more weight (currently 41 pounds down) but I'm not really hopeful. He's said that the only thing we can do to truly resolve it is another surgery. Am now concerned that I need to do that sooner than later if it would be considered WLS to be sure it's covered.

Am also wondering though if that surgery should be covered by the surgeon since it's a problem arising from the original banding. I'm unclear on just where to turn to get answers to these questions so am starting here.

Thanks.

Katy517 · June 15, 2010

Bump.

Really hoping that somebody here has experience with switching insurance coverage after banding.

Help please...

feedrate · July 23, 2010

Well the same thing happened to me. I had UHC ppo when I had my band put in. I changed from being on my wifes paln to my jobs plan. Still UHC ppo but new plan had exclusion. I started having problems and UHC told me that If I was spiting up blood and they could tie it to the band that they would pay for nothing. They said nothing, that is nothing that they can say was caused by the band. I think I now have erosin and don't know what to do. The ins. co. said they would pay for the scope down the old mouth but if the test shows problems, oh well IM on my own. I don't think it is right but what can you do. My Dr. says he will give his time for free but that leaves the sleep dr. the hospital, the xray dr. the floor cleaner, the window cleaner, the admin. new car allowance and on and on and on.

Sorry for this news but that is what I know about it as of today.

good luck

:biggrin:

Katy517 · July 23, 2010

Really sorry to hear of your band and coverage problems feedrate. I wish you the best of luck and hope that maybe an appeal will be the answer. Please keep us posted.

Katy