UHC Won't Cover My Surgery

[skyeblu79 0]

Hi,

I just found out my insurance company (United Health Care) will not cover the procedure. :confused: I have been told since January that it would be covered if approved. I called back yesterday and I was told the previous representatives were wrong and that it isn't even covered under my type of plan.

I have wasted my time, my doctor's time, energy, and money for doctor's appointments.

Basically, I am just really disappointed. :cry My doctor and I both thought I had a good chance of being approved. I thought I was doing everything wrong and it has just turned so wrong.

Does anyone know any other avenues? I plan on calling the insurance co. back today just to double check, preferrably w/a supervisor this time. I did ask the rep yesterday to send me a letter and the part of my plan showing that the surgery isn't covered.

Any help or advise is appreciated.

Thanks!!!

[barbara465 2]

I have UHC and was approved. My plan is under a PPO, so I don't know if that makes a difference. UHC is band friendly so it has to be your particular plan that is the problem. Sometimes employers chose to exclude certain procedures. Dig a little deeper and see what the real issue is. Hope this helps.

[FunnyDuddies 6]

I have United Healthcare, and I was told by a setup coordinator that set up my husbands employers insurance coverage that UHC is giving huge cost breaks to employers that exclude the surgery. they are phasing out the ability to have the surgery through the employers. so in reality they "used to be" band friendly. my husband's employer is a small company so they took the break, which means they have the exception, and that means no insurance coverage for me. The rep said that they are doing this due to the high mortality and complication rate from GB and lump lapband in with it.

yet one more reason to hate insurance companies lol

[skyeblu79 0]

Thanks for the quick replies. So, there is basically nothing I can do. I just hate that UHC had me running around for 4 months and my hopes up.:cry

[FunnyDuddies 6]

if you call up and ask about your policy, request that you be told if it is an exclusion, or some other reason you will be denied. Also, ask for a copy of your policy to be sent to you so you have it in black and white. if there is not an exclusion, then fight. some people go through 2 or 3 denials before getting approved. some insurance companies have that as part of the approval process to weed out the wishywashy

[Hedwig 0]

Don't get your hopes down. Like barbara said dig a little deeper. I don't have insurance I am self pay. But I had to find a way to get a loan. It took a year of hard work but I got it. How about payments. Lots of hospitals do financing. Maybe look into the wish center. they charge 10,800. Most other hospitals charge 15-17,000. I am sorry things are starting out like this for you. big hugs. I hope things workout for you.

[skyeblu79 0]

I will definitely dig deeper. I am going to call back today. The rep yesterday really didn't tell me much other than the other people I spoke w/were wrong. One of the main reasons I stayed with my company was b/c I thought the insurance would cover the surgery.

I really don't see self pay as an option. At least not at this point in my life. I don't make that much $$. I am in the process of starting grad school & that is going to tie up a lot of funds. If I finance, I am thinking it will probably be more than my car payment. Maybe after I finish grad school, but that is @ least another 2-3 years down the line.

[sleepyjean 0]

if you call up and ask about your policy, request that you be told if it is an exclusion, or some other reason you will be denied. Also, ask for a copy of your policy to be sent to you so you have it in black and white.

Exactly right. Get a copy of the policy so you can read the terms for yourself then you'll have more to base your argument on. Do you remember who it was who told you before that the surgery was covered?

[Carlene 12]

UHC seems totally wigged out in 2006. They paid for my surgery and my husband's in late 2004 (thru American Airlines). They paid for all our fills in 2005. Now they have denied fills. I appealed (twice) and spoke to about a dozen different people, all of whom gave me no real information.

Our benefit book said nothing had changed in 2006 (except co-pays on drugs), so I asked them to SHOW me where it said the fills weren't covered. They couldn't/wouldn't. You would not believe some of the dumb ass answers I got. One rep told me that they paid for the fills thru 2005 because we were still MO, but beginning in 2006, we weren't. I said, "And you would know this how???".

She said, "Well, you had LB surgery a year ago, so....".

"So what? Lots of people have LB surgery and are still MO a year later".

They are IDIOTS. But I finally got them to pay for our fills. I told them that if they would not show me where it said fills weren't covered, they could sure as hell show the union officials who would be calling them real soon.

The place that does our fills was amazed that I got them to pay. They said all their AMR people had been denied as of 1/1/06.

DON'T GIVE UP. Make them show you where it says you aren't covered.

I worked thru a department called "Rapid Resolution". Ask for them.

[skyeblu79 0]

Exactly right. Get a copy of the policy so you can read the terms for yourself then you'll have more to base your argument on. Do you remember who it was who told you before that the surgery was covered?

I'm not sure who is was, but the rep I spoke w/yesterday could see where I had spoken with @ least 2 other people. And all there phone are supposedly recorded, so hopefully if needed they could pull the phone calls.

So, maybe I should wait for the copy of the policy before calling back. It just doesn't seem far that they should be able to get give out false info like this. This is too important for insurance companies to be messing up.

[sallyjo 0]

I have UHC and they approved mine and refills also. Will be banded 4-25. Mine is also PPO. Make em diffy up and show you why not. Good luck.

[Carlene 12]

In many cases (American Airlines, for example), UHC simply administers the plan. AA is actually self-insured.

And some employers elect not to cover certain procedures in order to get lower premiums.

So....it's not really a UHC issue. It's an employer issue and you need to contact your HR dept. Or, if you belong to a big union, get them to help you.

[Alexandra 55]

Skyeblu, you haven't said whether you've got a large-group plan or not. If you do, then Carlene is right and it might not be a UHC issue at all. Do you have a human-resources department at your company that can give you straighter answers?

[skyeblu79 0]

The plan I have is called Choice Plus. I asked one of my coworkers and they said it is a large group plan. Later today, I will check with HR just to make sure. I looked on the UHC website and weight loss surgery wasn't listed under my plan as an exclusion. They had stuff like plastic surgery, etc.

[brneyezz 0]

It's going to depend on whether your employer put it as an exclusion on your policy. I would call your plan administrator in your HR dept, they should be able to tell you.