Need Insurance Advice

[Ralynda 0]

Hello,

I've decided that I want Lap-Band. I've done all the research and have been to a seminar. I even have a support system in place - my cousin and I want to do this together. BUT, here's my issue, I called my insurance company (United Health Care) and asked about my coverage. I was told that they do not cover this for me. So it's been a few weeks and I decided to call them again to see if I could figure something out and the rep told me that I do not have coverage for this procedure. So I asked if there was anything that could be done and she (the rep) said that even with a letter of medical necessity they would deny it because I don't have that coverage. Her advice was to wait until open enrollment and pick a plan that does offer that coverage.

My question is this: should I follow her suggestion, or is there a way around the "you don't have this coverage" issue? My BMI is 45, so I'm well within the scope, but I have no co-morbidities. UHC spends very little on me yearly in medical fees, so I don't believe they would think it was a medical necessity.

Any advice?

[shawna_s 8]

Hello,

I've decided that I want Lap-Band. I've done all the research and have been to a seminar. I even have a support system in place - my cousin and I want to do this together. BUT, here's my issue, I called my insurance company (United Health Care) and asked about my coverage. I was told that they do not cover this for me. So it's been a few weeks and I decided to call them again to see if I could figure something out and the rep told me that I do not have coverage for this procedure. So I asked if there was anything that could be done and she (the rep) said that even with a letter of medical necessity they would deny it because I don't have that coverage. Her advice was to wait until open enrollment and pick a plan that does offer that coverage.

My question is this: should I follow her suggestion, or is there a way around the "you don't have this coverage" issue? My BMI is 45, so I'm well within the scope, but I have no co-morbidities. UHC spends very little on me yearly in medical fees, so I don't believe they would think it was a medical necessity.

Any advice?

I could be wrong, but if you don't have the coverage, I don't think you have any options. My only suggestion is to maybe check into getting an individual plan through someone else. I am checking into this as well, but I heard that individual plans don't cover it either, only group ones. I don't know if that is true at all, but that is what I read. Hopefully you can find something out soon! Good luck!

[SewHappyInFlorida 1]

I am in the very same situation with Health First Insurance,with the exception that I was given some misinformation. So I gathered all my information ie. Five year diet history withrecorded BMI,

I got the letter of medical necessity from my doctor.

I went to the seminar, psych and nutritionist then back tothe surgeon for my consult…. I jumped through all the hoops, only to find outthat my insurance will NOT cover the surgery.

I have appealed twice, now I am done.

And a second insurance will not cover iteither, it’s then considered a preexisting condition.

Sorry to be the bearer of bad news, but I wish someone toldme before I got my hopes up and paid for the psych & nutritionist visits.

So like you I will be counting down the days till openenrollment. It just sucks because I am at a 40 BMI right now and if I lose afew pounds than no insurance will cover it.

I’ve been on a diet for last 20 years, so to try and maintain280 lbs. seems ridiculous!

Even worse than that I’ve heard stories of people actually gaining10- 20 lbs just to have the Lap Band!?!

I believe it is completely negligible how the health industrytreats those with this disease (obesity).

Could you image finding out you have cancer and being deniedcoverage by your health insurance company!

“Sorry there’s a Cancer Exclusion in you policy”…

OK I think I might be done with my rant now.

[Alli in StL 23]

I agree. I think you're out of luck. Not all insurances cover everything. It sucks, but that's the way it is. Definitely try to get a plan that covers it during open enrollment.

Hello,

I've decided that I want Lap-Band. I've done all the research and have been to a seminar. I even have a support system in place - my cousin and I want to do this together. BUT, here's my issue, I called my insurance company (United Health Care) and asked about my coverage. I was told that they do not cover this for me. So it's been a few weeks and I decided to call them again to see if I could figure something out and the rep told me that I do not have coverage for this procedure. So I asked if there was anything that could be done and she (the rep) said that even with a letter of medical necessity they would deny it because I don't have that coverage. Her advice was to wait until open enrollment and pick a plan that does offer that coverage.

My question is this: should I follow her suggestion, or is there a way around the "you don't have this coverage" issue? My BMI is 45, so I'm well within the scope, but I have no co-morbidities. UHC spends very little on me yearly in medical fees, so I don't believe they would think it was a medical necessity.

Any advice?

[Grider 92]

You play for a plan , the plan is picked by your employer, unless it's medicaid, and they choose the types of coverage that will benefit their employees. Until the law changes, this is the way it works. I do not know about pre-existing conditions, I believe that was changed, but again for morbid obesity, it is slippery, even though people die every day because of it. You need to push the envelope in your state and on the job. There are credit cos that will help finance and the prices have dropped, but that is what you have to work with.