EMPLOYER/UHC Excludes LB!!!

marz88 · May 31, 2006

That is so sad! My husband has bc/bs through his work and they quit covering the band 01/01/2004. But they still covered bypass! When I found this out, I was torn. I DID NOT want to do bypass. Finally through a co-worker at my work I found out uhc did cover it. But I had to wait until an enrollment period came around, then had to wait for the first of the year. My surgery was 2 weeks ago (May 18th) and I'm waiting for the bills to start rolling in. Right before I got the approval from insurance, I found out my Dr is 'out of network' which can work to your advantage or severely against it. So I'll continue waiting. And if I end up paying a few thousand dollars, it's still better than self-pay either here in the states or Mexico where sometimes you have a problem finding a Dr to do maintainence.

Iulizbug · June 1, 2006

Yep--Same thing happened to me with UHC. I had co-moribities, three actually but they weren't severe enough to qualify me. I guess they pretty much wanted me 6 feet under at 25 yrs old to qualify!! Absurd!! I was VERY LIVID after the denial but now that I am happily banded on losing I am over it. UHC is definitely tightening up on coverage for WLS. I wouldn't be surprised if they don't cover it at all in a few years. More $ for them...:angry

~Liz~

banded 03/10/06

Dr.Ortiz

241 highest/237 surgery/205/150

5'7''

ousooner · June 19, 2006

Sorry to hear your going throught this. I have UHC and had my surgury 5 weeks to the day aftet I had my consultation! I have never been through an easier process. In fact, when I went back for my consult, the doctors coordinator said " Oh, you with XXXXX company and UHC, you should get approved easily. I wonder how much of this is your companies restrictions. Good luck. I had the problem your going through a couple of years ago when our company had Aetna and gave up all together. Don't give up, keep trying.

JMO · June 19, 2006

My husband work for an ins. company for 5 years. It's not UHC you should be angry with, Your employers are the ones who chose the policy. UHC DOES COVER LAP BAND, your employer chose not too.UCH approves LB for BMI Over 40 or 35 w/ comortalites, Your company adds the other stipulation(spelling?) I know is time consuming and a pain in the rump, but if you want to fight it, go to your HR. company. The company my hubby worked at did not cover any WLS but one of the men he worked with, needed it so he kept fighting, getting proof and other employess suport and signatures. The company has now wrote it back into the policy and he had his surgery two months ago. That was after a 2 year battle, but self pay was not an option.

My point is if you want the surgery, and you don't want to do RNY, give your employee proof that LB is not riskier, Give the the info so they HAVE to make an informed decision. Maybe they can review it and approve it during open enrollment... My advice is fight, fight, fight, and don't settle on a surgery that you don't want.... Good luck....

SALEMKITTY · June 20, 2006

I too have UHC insurance. We had a written exclusion relating to any type of weight loss surgery even if the person is morbidly obese. I asked me boss and he asked the upper mgmt. but they said it would not be covered. They also said any surgery relating to complications with the band would not be covered. I decided to self pay. I am worried about the chance of complications related to the band.

michele6789 · June 21, 2006

My original surgey date was this morning:think . I canceled it because I am trying to fight my insurance company so they will possibly cover the lap band surgery. You know, I feel like every one is dropping the ball. I have found that the person who is involved with the insurance aspect of this doesn't seem to be sending the correct information to my insurance company and of course they claim that they never receive anything that is sent. I just want to be healthy and like so many of you I know that I will probably be self pay but I have to try and see if the insurance will pay!!!

How can I do that if the doctor's "insurance expert" won't help me in the things that I am trying to do. I've thought about changing doctors but I like the surgeon that I have chosen and then I would have to start all over with another doctor.

Any advice out there? Thanks for letting me vent.

Pissed off in Wyoming

Michele

marz88 · June 21, 2006

Hey Michele

I don't know how far into WY you are, but I went through Scottsbluff NE doctors, Forney and Holloway. Their office people were FANTASTIC!!! Laura was the one I contacted each time I was told to call back concerning my approval. She did so much leg work for me. In the end, I had to call the insurance company because everytime she called she couldn't understand the accent of the insurance rep. When I called, I got a very American sounding person who said, "Yes you were approved and your letter was sent 4 days ago to tell you that". Music to my ears! You didn't say what kind of insurance you have and if you should happen to be a self pay patient and go to Mexico, the doctors in Scottsbluff will do your fills and maintainence. They take care of a lot of patients from Colorado because they have a hard time finding a follow-up physician. Good luck and don't give up!

JMO · June 21, 2006

My original surgey date was this morning:think . I canceled it because I am trying to fight my insurance company so they will possibly cover the lap band surgery. You know, I feel like every one is dropping the ball. I have found that the person who is involved with the insurance aspect of this doesn't seem to be sending the correct information to my insurance company and of course they claim that they never receive anything that is sent. I just want to be healthy and like so many of you I know that I will probably be self pay but I have to try and see if the insurance will pay!!!
How can I do that if the doctor's "insurance expert" won't help me in the things that I am trying to do. I've thought about changing doctors but I like the surgeon that I have chosen and then I would have to start all over with another doctor.

Any advice out there? Thanks for letting me vent.

Pissed off in Wyoming

Michele

I know you don't want to start over with another dr. But it would probley be less headach. I did all the stuff my doc asked and they did EVERYTHING else. I was approved in 10 days.. if you have a doctor's office that will hold up their end of the bargain you should not have to do much. If it were me I would change drs. and get one that will fight for you not against you.. good luck...