I called Dr. Spivak's office this week and tried to make an appointment for my very 1st fill. I was told that since the insurance covered the surgery they would have to submit a request to UHC would they be willing to pay for my 1st fill. Apparently this is a new policy with UHC, but I don't think this "new policy" makes sense! Why would they approve me for the lap band, but have then I would have to wait 3-4 weeks to hear if they approve paying for the fill (which would be my very 1st might I add). Wouldn't that defeat the purpose of getting the lap band in the 1st place??? This is crazy! I need my 1st fill bad. I have no restriction at all!

Is anyone else having the same problem?

Eclipse

This same change has affected patients with Cigna. As of april 1st the providers have to send in medical necessity and it has to be reviewed.

STINKS!!

This is a question that I have been meaning to ask. I also have UHC. If they are not going to cover the fills than like has already been stated it defeats the purpose of having the surgery done in the first place. I have preop on 5/8 and this will be the first question I ask. I guess the only thing we can do if its not covered is treat the fill like any other bill we have to pay and put it in the budget.

It probably depends on the employer's policy/specifics. I have UHC and they cover fills. In fact, I just got an EOB this week where they paid on my DH's last fill.

I have UHC and they did not cover my fills. I have 1k out of pocket so far.

I don't have UHC, but my insurance will not cover the fills either. I don't quite get that, so I paid $5,500 upfront which gave me 5 years of aftercare, including fills. Insurance covered my operation only. Would do it again though.

hi,

from my understanding...

the policies are established by the employer not the insurance company. UHC administrates based on what the employer wants to pay for the insurance.

Wow, this is a tough situation for some of you. But, at least your insurance covered the surgery. My employer stopped covering the surgery all together so I had to pay 13K out of our savings. :-( Ugh! At leasy my doc covers the first year of fills for free. Thank goodness!

hi,

from my understanding...

the policies are established by the employer not the insurance company. UHC administrates based on what the employer wants to pay for the insurance.

Correct. Our UHC is thru American Airlines, which is actually self-insured. UHC merely administers the plan for AA.

I just had my first fill done on 4/10 (surgery was 1/31) and UHC paid for it. It was done via Flouro.

I had mentioned to my Dr staff about what I have read here with UHC and she had said that if they were changing their policy "overall" and not paying for fills they would have to wait a year (after "publizing" it I am guessing) before they could actually implement this change. The person I spoke to work in the medical insurance industry for 10 years and knows the regulations as to what the insurance company must do before implementing the change. She also had not heard about this being an issue with UHC.

So it maybe employer benefits verses the insurance comapny itself.

I hope this helps.

Good Luck!

OMG I had the same problem! I had surgery on 01/31/07 and my insurance said I had to wait 3 months before they would pay for my 1st fill. OK I dealt with that but when I scheduled my appt for the 1st fill they said sorry. I was persistant and called the insurance company everyday and they finally approved my 1st fill on 05/23/07. 4 months after surgery.

Makes no sense that insruance would cover surgery @ $27K plus and then say sorry we aren't paying for fills.

well that is one of the reasons I do my own fills and I hve had them check by my doctor and he asid they looked to be just like the normal fills so I never go to the doc any more as I am my own filler .

Stacey- LUcky duck! Maybe you can teach the rest of us how to do our own fills! Nevermind, I don't think I can handle doing it myself.

lucky you have insurance!!terry

Wow it sounds like UHC SUCKS!!! Sorry to hear that. It makes no sense to me at all why they would do this.

Inamed, or what ever there called now should really get off there butts and get some proff to insurance companies and employers about the band! What is wrong with them!

I went to a support meeting today for WLS and half the room was bands the other half bypass. So many bypassers have had to go back in for revisions! How scary is that! This just make me so MAD!!!

Maybe when J&J come out with there band they will know how to inform the right people including Medical staff!!!