Hey guys,

I've been exploring surgery as an option for several months now, doing research and such. I recently learned that my employer has WLS as an exclusion on our plans (we use United Healthcare) so I would have to pay for all of it out of pocket. :/

I have a couple of questions, though (just need some help, I'm a complete newb at insurance). We're about to have open enrollment again for the company next week, should I consider ditching insurance through my employer and paying for a different plan through a provider that does cover it?

Or should I see if there's a different/supplemental plan my employer/UHC has that does cover WLS?

Sorry if any of that is jumbled or confusing, I'm just looking for some advice to see what I should do next.

Thanks in advance!

Agreed,it is not UHS, it's definitely my employer and the selections they made going with UHS. One of the local bariatric centers does free insurance checks and got back to me on that and said it seems to be an employer driven exclusion. I plan on asking our HR rep later today if there is an additional plan I can get that covers WLS or something else I could do. After that I am looking into just paying it myself. The center I'm looking at (Kim Bariatric Institute) has an affordable program where lap band or sleeve can cost as low as $4900. I would most likely qualify based on my income. I'm worth it and I'm not giving up on this. I really appreciate all of your answers, sorry I couldn't reply individually but I did read every word and it all helps. Thanks!

So there was a post about this a few weeks ago about someone who went back/wrote a letter to their enployer on the cost of non weight loss coverage.

Many employees unfortunately don't see the forest for the trees, but it is changing. The industry is pushing health and wellness and not sick care, he was able to show the potential down the road costs to an employer of being obese and not paying for wls.

I will try to find and send you link please share with your employer

So there was a post about this a few weeks ago about someone who went back/wrote a letter to their enployer on the cost of non weight loss coverage. Many employees unfortunately don't see the forest for the trees, but it is changing. The industry is pushing health and wellness and not sick care, he was able to show the potential down the road costs to an employer of being obese and not paying for wls. I will try to find and send you link please share with your employer

I'd love to share that with them. There are quite a few people here who would probably pursue the surgery, if it were available to them. I appreciate that!

Skinny,

Fully insured does not mean the sky's the limit. There's a basic policy available and then there are riders the employer can add to the policy. Each rider has a cost associated to it and is added to the monthly premium the employee pays.

Riders include: Bariatrics, DME(durable med equipment), cosmetic surgery, dental, eye care, infertility, self inflicted injuries and so on.

Each employer designs a plan that is affordable and fits the patient population of the existing employees. Your "Fully insured plan" must have had the coverage you needed but it's still up to each employer to purchase the coverage it feels will fit their needs.

No argument on UHS being the evil, amoral company you describe.

Don't work for UHS

Ddont want to unless im desperate

The people I know who work there aren't happy either. It's the policy makers not the folks you get who really are trying to help you

I have had UHC for many years. My company chose to exclude WLS. They finally just added it a year and a half ago. I believe the company decides on what to exclude, no reason why UHC wouldn't allow a company to have it as long as they paid for it. Which that may have been the issue, extra expense. Best of luck!

My husband and I are in a similar situation. We live in Texas and have UHC through our employers, but WLS is covered by our plans. However, the way the surgery is covered is separate from the way everything else is covered and has it's own special deductibles and co-pays. Long story short, once you've finally jumped through all the hoops (including a year-long medically supervised diet) and been approved, you are still going to end up paying a minimum of $18,000 out of pocket.

We also talked to Dr. Kim's office about the Making Bariatrics Affordable program, but ultimately we decided to go with the Dallas Bariatric Center, with Dr. Jayaseelan. They have a similar program, and it will end up costing up approximately $4,800 each for the surgery. We've already had our initial consult with Dr. Jay and plan for my husband to get sleeved in September and for me to get sleeved once we can save up enough money to pay for it. At the very latest, it would be September 2015, but I'm hoping we can make it more like March or April 2015.

My husband and I are in a similar situation. We live in Texas and have UHC through our employers, but WLS is covered by our plans. However, the way the surgery is covered is separate from the way everything else is covered and has it's own special deductibles and co-pays. Long story short, once you've finally jumped through all the hoops (including a year-long medically supervised diet) and been approved, you are still going to end up paying a minimum of $18,000 out of pocket. We also talked to Dr. Kim's office about the Making Bariatrics Affordable program, but ultimately we decided to go with the Dallas Bariatric Center, with Dr. Jayaseelan. They have a similar program, and it will end up costing up approximately $4,800 each for the surgery. We've already had our initial consult with Dr. Jay and plan for my husband to get sleeved in September and for me to get sleeved once we can save up enough money to pay for it. At the very latest, it would be September 2015, but I'm hoping we can make it more like March or April 2015.

The more I talk with Dr. Kim's office about insurance and the more I talk with my employer I am highly considering just saving my own money and selling a few things to do this. I have a consultation later today so I will learn more then but the more I look at it financially, it is probably cheaper for me to pay cash. Still worth it. I hope everything works out for you and your husband as well!

Okay guys, I wanted to just thank all of your for your help! Really, I appreciate it and it made making this decision a whole lot easier.

I have decided to just pay for it on my own. There's no way my company is going to add this to their policy and unfortunately I don't feel like wasting my time trying to get them to do it. I'm going to contact my local bank and see about getting a loan.

I had a consultation with Dr. Kim earlier and he and his staff were very helpful about what I needed. They were very straightforward about the pricing and I liked that. I know it costs a lot but I still really want to do it because I don't feel like spending the rest of my 20s like this. I just wanted to give you guys an update and say thanks for all the help!

I had United Healthcare when I first started looking into surgery. My surgical coordinator told me it is very difficult to get approved for WLS through them. Some plans will cover it, but you have to do these supervised nursing calls and if you miss even one, you get denied.

So I dropped United and shopped around. I found BCBS was the best plan that covered the most, including the surgery. Their only criteria for approval were that you had to follow your surgeon's pre-op regimine (set by the surgeon, not BCBS, so that's all your pre-op testing and one nutritionist visit), six months of doctor supervised weight loss attempts, a letter of medical necessity from said doctor and weight history for the last two years from any source (ER, PCP or OB/GYN). The only other exclusion would be if you'd had WLS in the previous two years.

That said, I paid about $4000 out of pocket for the policy for the few months I needed it, then switched to a lower plan. It is a little less than what some pay to go to Mexico, and though it was expensive initially I had the assurance that my surgeon was just around the corner if I need something or something goes wrong.

Honestly, it was the best $4000 I've ever spent.

I would buy a private plan first before I took a loan.

I have UHC as well and my surgery was covered. It depends on what policy your company chose. They picked one that excluded WLS to save money. Issue is with your company and not UHC.

@@phewforaminutethere I can't believe no one has mentioned it yet. there are many people on here who have gone to Mexico for the procedure. I think many people are paying around 3500-4000. no insurance to deal with. I never looked into it too much because my bcbs covers the procedure. there is a sub-forum on here somewhere for mexico procedures i think. either way, best of luck to you.

Okay guys, I wanted to just thank all of your for your help! Really, I appreciate it and it made making this decision a whole lot easier.

I have decided to just pay for it on my own. There's no way my company is going to add this to their policy and unfortunately I don't feel like wasting my time trying to get them to do it. I'm going to contact my local bank and see about getting a loan.

I had a consultation with Dr. Kim earlier and he and his staff were very helpful about what I needed. They were very straightforward about the pricing and I liked that. I know it costs a lot but I still really want to do it because I don't feel like spending the rest of my 20s like this. I just wanted to give you guys an update and say thanks for all the help!

Hi, so Im curious, did you go with Dr Kim to do your surgery?

what about appeal thru Lindstrom? (not affiliated)

wlsappeals.com

they couldn't help me with my denial but they were helpful to point me in the right direction. There is no cost to call & get opinion; they are up front about being able to help or not.

Hi

I also have UHC with a self funded plan. The policy states you must be over 21, have a BMI of >40 with a 5year medical history of BMI> 40 or

BMI of 35 + 2 co morbidies.

I have the 35 BMI with 5 co morbidies and am currently on a 2 level appeal. Make sure you check the fine print of the WLS exclusions. I'm told by many that usually after the 2 level appeal they change their opinion and give you approval. Fingers crossed, I hope so. I have already done the pre op, psych eval, nutrition and surgeon consultants and pre op diet and was denied my pre cert 3 days before surgery.

Thank goodness my surgeon is fighting for me. Hope you find what you need to move forward.