I have received a letter at my on set of my journey in April that I qualify for VSG but that their is no guarantee of payment. I am doing the 6 mo monitor with my PCP and I have 3 co morbidities. My surgeon insurance lady --- says I have to pay up front and they will refund what the insurance pays. This just doesn't sound right to me has any one else experienced this with united healthcare choice plus??? Looking to have surgery 1st of October.?????

Hi ABJ. If you are going to a Network Provider, it is probably written in their contract that they can not make you pay upfront. They should only have you pay the expected co-pay or co-insurance amount. If this is not a Network Provider, then they can make you pay in full upfront.

I have worked in health insurance and medical billing for years. It would be best to stay in network.

United also seems to pay the worst of all the insurances so they may be trying to get you to buffer their payment.

allons-y

I have received a letter at my on set of my journey in April that I qualify for VSG but that their is no guarantee of payment. I am doing the 6 mo monitor with my PCP and I have 3 co morbidities. My surgeon insurance lady --- says I have to pay up front and they will refund what the insurance pays. This just doesn't sound right to me has any one else experienced this with united healthcare choice plus??? Looking to have surgery 1st of October.?????

I have choice plus with a 1500 deductible. And 750 co insurance. So the max I had to pay was 2250. I really didnt have to even pay that much because we have a medical reimbursement account through Jp Morgan chase. They have been great so far, in my experience. You should not have to pay up front. Only thing I had to pay was a $300 fee for supplements, preop class and nutrition classes that were not covered by insurance.

Thanks to all, moving forward????

I have received a letter at my on set of my journey in April that I qualify for VSG but that their is no guarantee of payment. I am doing the 6 mo monitor with my PCP and I have 3 co morbidities. My surgeon insurance lady --- says I have to pay up front and they will refund what the insurance pays. This just doesn't sound right to me has any one else experienced this with united healthcare choice plus??? Looking to have surgery 1st of October.?????

I have United Healthcare. Not sure if it is Choice Plus or not. The approved me, and my doctor gave me a figure I owed him LESS what he would get from United Healthcare. It was slightly adjusted downward from the original quote. I am not expecting to get anything refunded to me, however, if I do, it will be a bonus. Hope this helps.

I have received a letter at my on set of my journey in April that I qualify for VSG but that their is no guarantee of payment. I am doing the 6 mo monitor with my PCP and I have 3 co morbidities. My surgeon insurance lady --- says I have to pay up front and they will refund what the insurance pays. This just doesn't sound right to me has any one else experienced this with united healthcare choice plus??? Looking to have surgery 1st of October.?????

I looked up my approval letter from UHC today, and it had the same language, "no guarantee of payment, blah, blah." My surgeon didn't make me pay up front. In fact, when I asked what my part would be, they told me it could be 1,250 -- but to wait until the insurance paid, then see what was left.

The insurance paid 44,000 for the surgery and hospital stay. My part was a 250 co-pay for the hospital stay. My experience may be atypical, as I had a bunch of other tests earlier this year which went towards my out of pocket.

If your surgeon wants you to pay up front, you might want to check to see if they are a "Center of Excellence" and in network. You might also want to go surgeon shopping. If you are in Chicago, I can recommend mine.

Good luck!

I also have UHC ChoicePlus and was told by two different doctor's offices that my employer's coverage has a specific exclusion for WLS, regardless of any co-morbidities (of which I have three). Has anyone else been told something similar?

You need to check with your ins co-- not the drs office. They have the last word. Also, with my letter in hand - I called ins co and they said I was not covered- kept persisting ( I have a letter). Finally got to the right person. This process is brutal---but don't give up until you are sure. The company you work for may have excluded WLS from your policy even though we both have UHC choice plus. I was told today it could take 2-6 weeks to get final approval- after completing all their hoop jumping- I am bummed. But not giving up- This will be so worth it. Hope it works out for you.

You need to check with your ins co-- not the drs office. They have the last word. Also, with my letter in hand - I called ins co and they said I was not covered- kept persisting ( I have a letter). Finally got to the right person. This process is brutal---but don't give up until you are sure. The company you work for may have excluded WLS from your policy even though we both have UHC choice plus. I was told today it could take 2-6 weeks to get final approval- after completing all their hoop jumping- I am bummed. But not giving up- This will be so worth it. Hope it works out for you.

Thanks abj for the reply. What letter are you talking about - just a letter from my PCP recommending surgery or a letter from the WLS surgeon?

No, sorry I didn't make that clear. Unitedhealthcare sent me a letter saying that my request to cover procedure (43775) which is sleeve surgery, is eligible for coverage. But not a guarantee for payment until actual claim is sent in. They require prior 6 mo notification of surgery and during those 6 mo, weight management monitoring. I am in my 5 month now. Hope this helps.

Ajb - thanks again for the info, I am going to call UHC and see what I can find out.

I did learn that UHC has good coverage if I have a hiatal hernia. Two doctors have told me that if an EGD reveals a hiatal hernia, insurance would cover that procedure and they could do the VSG for around $5,000 - $6,000 as an "add on", so I'm now in the unusual position of kind of hoping that I have an HH. (I don't have GERD or acid reflux more than once or twice per month, so I'm doubtful.)

I have UHC, unsure if its choice but My coverage works through a company called BRN (bariatic resourse network) and they have been nothing short of GREAT. I have called several time to verify and it has been confrimed each time that it IS covered, and to beat without a diet period. I still have to check with the hospital to see if they are going to get me to cover my part up front because our deductible is really high ($3500) but i do have almost $1200 in my HSA and $400 on my FSA so thats $1600 of my $3500 hopefully they will take that and let me pay down the rest. We will see......

kind of a dumb question. I have oxford insurance. Its a cheap policy that I have been paying out of pocket for. I did the whole 6months of seeing a primary care doctor. I got an endoscapy, chest x-ray with breathing test, letter from a shrink, letters from the surgeon and my primary care doc, and a bunch of other things. So I got approval and I am slated for surgery on wed.

I was looking through a packet that oxford sent me about a month ago. Just a standart packet showing policy benefits and limitations. On one page there was a list of excluded proceedures and bariatrics was on that list. Now I know they cover the surgery because about a year ago when I was checking out different doctors one of the nurses called my insurance co with my policy number and type and was told the surgery is covered. So I just find it strange that in that list bariatrics would be something NOT covered.

So should I be worried? I mean I have approval and whatnot. They cannot just refuse to pay the surgeon after they approve someone right?

also I was looking at the benefits section and I will have to pay a small co-pay for the 2 day hospital stay which is fine. I am worried about them paying for the surgery in full and the anesthesia. Now I know the anesthesiologist takes my insurance and since im approved for the operation.....

I would love for someone to chime in here. Do you think the insurance company has to pay everything in full since they approved me or could they screw me over and say we approved you for the surgery but we are not paying......

idk maybe I am just over reacting.

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I hope we are both over reacting -- but my insurance girl at surgeons office says they can do just that. You should contact them periodically yourself

Went through this with my lapband six years ago. Double check, but Bariatrics are probably excluded, however your surgery is to correct your medical condition or co-morbidities not simply for weight loss. Does that make any sense?

It's kind of like they will pay for a tummy tuck but only if it is impacting our daily living by becoming infected.