The codes my Dr provided me are an EXCLUSION per United Health Care (my plan).

Any suggestions before I self pay?

I am switching to that plan. Is there someone in your wls office that knows the ins and outs to have the appeal?

The codes my Dr provided me are an EXCLUSION per United Health Care (my plan).

Any suggestions before I self pay?

I have united health care and they paid 100% I only paid 2 dollar copays at my doctors office. My daughter had to get an attorney to get hers paid for, her surgery is not for 9 months though.

Ill check. But UHC told me its excluded coverage. Even if medically necessary. I guess I could appeal, but I don't wanna go through that stress.

Ill check. But UHC told me its excluded coverage. Even if medically necessary. I guess I could appeal' date=' but I don't wanna go through that stress.[/quote']

I went through the stress, it was worth it!

How long did the appeal with UHC take.

I might pay, them try to get them to reimburse me.

Even thought seems both of you have uhc, the plans must be very different. I would also ask your employer or whoever " provides" your insurance for a copy of the SPD and see if the exclusion or bariatric surgery is addressed. If not, that could help you appeal.

I work for the state of Florida and have UHC paid 100 % approved first time my Dr office follows strict guide lines which for UHC was over kill but well worth it UHC requires 6 months of supervised diet, physic report but it was cool

I have UHC, but my employer has chosen a plan that excludes bariatric surgery. It all depends on what your employer has chosen.

It all also depends on the coding that your doctor uses. See if you can get it coded by the hospital under a different code such as gastrio intestinal.

Best of luck to you!

It all also depends on the coding that your doctor uses. See if you can get it coded by the hospital under a different code such as gastrio intestinal.

Best of luck to you!

As a medical coder I can tell you for sure that it is NOT because of a code. There is only 1 code for insertion of a Lapband device...and all Lapband surgeons offices use that same code anywhere in the US. So if there is an exclusion it is because the OP's employer chooses not to include the Lapband in there plans.

Furthermore asking the hospital to change a code so you can get a procedure approved, or a hospital/doctor's office changing a code for you to get a procedure approved is considered fraud...which could carry a HUGE monetary fine and/or time in jail...just FYI.

As a medical coder I can tell you for sure that it is NOT because of a code. There is only 1 code for insertion of a Lapband device...and all Lapband surgeons offices use that same code anywhere in the US. So if there is an exclusion it is because the OP's employer chooses not to include the Lapband in there plans.

Furthermore asking the hospital to change a code so you can get a procedure approved, or a hospital/doctor's office changing a code for you to get a procedure approved is considered fraud...which could carry a HUGE monetary fine and/or time in jail...just FYI.

That's good to know about the coding.

What I meant was more the "reason" for the band. If they used a gastro to say that it was necessary in addition to the weight issue and any other co-morbidity. If it's excluded for only weight but not for a medical necessity.

There are procedures out there now in gastroenterology that place a ring similar to lapband but a metallic kind of spring, to help with digestive issues, I myself have those digestive issues and the lapband is serving a duo purpose for me, even though I did not have any such employer exclusion on my UNHC policy.

I would never ask anyone or suggest to anyone that they commit fraud but to see if there are other avenues that can be explored to go around the exclusion.

I had UHC and under them I could not get the procedure also I found out the through them if you have a PPO that it is not covered. I switched to BCBS HMO and it is covered. I have the same employers but they offer two different companies and plans. When UHC told me no, I gave up until I at talked to another colleague. Not sure if this helped, but if you have more questions this is a good place to ask.

I live in Georgia and have United Health Care! I had to pay out of pocket. They would not pay!!!

We are changing to Blue Cross Blue Shield and they would have paid!!! Just my luck!!!