I just found out that my employer has extra requirements that require hypertention and or diabetes to get approved for lapband. The 2 HAVE to be uncontrolled meaning you have to be taking meds for the diseases AND they have to be NOT working!!! Those are my employers rules! My case handler I talked to at the doctor’s office talked to united healthcare and she said if my job didnt have those extra requirements I would've already been approved because my BMI is so high She told me to call HR and benefits and see if they can exclude me from the extra criteria because my BMI is so high. I can’t believe this crap! Also she said whatever we do, don't cancel the UHC insurance. It's supposedly the most bariatric friendly insurance. She said if we cancel and try to go individual using ANY insurance company, I will get denied because my health is so bad. If there is a slim chance of getting approved with any other insurance our premiums would be so high it wouldnt be worth it. My only hope is getting those requirements overturned with my job and or getting another job with UHC as their insurance that doesn’t have those extra stupid requirements. Just thought I’d share….I'm beyond FLAMING P*****!!!!

Edited March 25, 200818 yr by Kimmie K

Hey Kimmie, I am so sorry for this and I would be pissed too. My husband's insurance is UHC and his employer has a total WLS exclusion. I saw no point in trying to fight that as he is employed by the state. So I went out of state and self-paid. Good luck with this and don't give up...you will get there. There are a lot of people on here who have been through this with their employers and insurance, I am sure you can find some tips on how to get this covered.

:biggrin: Thanks so much! I was given the number to corporate for my employer. I called and had to leave a message for the lady. Now I'm just waiting again. I SO hope they can overturn this because the approval will be immediate from UHC. No one can say this is the easy way out of anything because sure hasn't been a walk in the park!!! More like a walk through a psychiatric hospital...or at least that's where I'll end up, LOL!

what kind of work do you do?

My employer a school district, one of the biggest in my area, does not include it in their medical benefits either. I know I'm going to be denied via my insurance company then have to appeal that will most likely be denied and then the second level appeal is at the company level. I have emailed the Benefits lady and she hasn't gotten in contact with me as of yet. I'm hoping to speak with her, be pro active you know so that she know's what's coming down the pipe and could maybe, hopefully talk with the insurance and say to go ahead and approve the surgery b/c she's spoken with me. I don't plan on being banded til June anyways, b/c of school so I can wait for the appeals to go through if she doesn't get back with me soon!

My employer a school district, one of the biggest in my area, does not include it in their medical benefits either. I know I'm going to be denied via my insurance company then have to appeal that will most likely be denied and then the second level appeal is at the company level. I have emailed the Benefits lady and she hasn't gotten in contact with me as of yet. I'm hoping to speak with her, be pro active you know so that she know's what's coming down the pipe and could maybe, hopefully talk with the insurance and say to go ahead and approve the surgery b/c she's spoken with me. I don't plan on being banded til June anyways, b/c of school so I can wait for the appeals to go through if she doesn't get back with me soon!

Definitely good luck to you too on your battle....the whole time I thought it was UHC but it was my freakin job! My case handlers said UHC is the most bariatric friendly insurance so I was like...what the crap! Why am I having such a hard time and no one else seems to.... I feel ya man, most definitely :smile2:

i was approved twice with uhc...both time took less than 2 weeks. my employer has great bennies, because they are so huge...usually a Fortune 5 company. yes, that is 5 , not 500

Well reading this has me concerned. We have UHC too, and I have had to battle them in the past to get things covered for my son. They seem to fight on everything - I surely hope that I don't have this issue!

I am so sorry this is happening. The funny thing is, if you had a heart attack or some other 'weight related' injury, they would cover THAT now wouldn';t they????

WannaBeMe

i was approved twice with uhc...both time took less than 2 weeks. my employer has great bennies, because they are so huge...usually a Fortune 5 company. yes, that is 5 , not 500

Glad you didn't have any problems...

Just thought I'd chime in, I can't believe the company has an exclusion! I have UHC too... I was approved within days. It's funny, when I went in I didn't even think of the possibility that my company might have some say!! That's crazy, def. keep us updated, I'm interested to see how things turn out.

Well reading this has me concerned. We have UHC too, and I have had to battle them in the past to get things covered for my son. They seem to fight on everything - I surely hope that I don't have this issue!

I am so sorry this is happening. The funny thing is, if you had a heart attack or some other 'weight related' injury, they would cover THAT now wouldn';t they????

WannaBeMe

Well, like I mentioned before, it's not really UHC that I ended up fighting, it's my employer. I haven't had to use the insurance for much else except for all the testing required for the band so I haven't had to really really fight UHC yet...and hopefully dont have to. But I hear everywhere that UHC is usually the quickest approval for bariatric surgeries. The only thing getting in the way for me way is me being overweight hasn't caused any health problems yet. In a way thats good and in a way that's bad I guess...

..good luck with your son and UHC... I'm sure everything will work out in the end for ya :blushing:

Just thought I'd chime in, I can't believe the company has an exclusion! I have UHC too... I was approved within days. It's funny, when I went in I didn't even think of the possibility that my company might have some say!! That's crazy, def. keep us updated, I'm interested to see how things turn out.

Oh trust me! Every step of this mess will be documented here. I find the more I get into this lapband world the more unique my case seems to get...so I'll be sharin'!

Hi,

I understand your frustration. I work for a private company that is self-pay- meaning the company pays the claims, not my insurance. I'm in HR so i knew this and decided to go the self-pay route (scheduled for 4/17) to avoid the hassle. Maybe your company is self-pay also? They would never advertise that to the employee population, but being in HR I sat in on the meetings.

It's frustrating, but many companies don't cover wls because it's $$$. Appeal it..it'll go to Sr. Mgmt and they will decide. They will not know who you are- just that X employee in X dept requests X for X reason. If they reject again, Appeal it again.

Sometimes though, companies do not have an appeal process in place for things like that. Find out from your corp. HR team. At my company it would be covered, but they'd know who I was because..i'm the only fat one in hr!! I don't want them knowing my business...

good luck!

Hi,

I understand your frustration. I work for a private company that is self-pay- meaning the company pays the claims, not my insurance. I'm in HR so i knew this and decided to go the self-pay route (scheduled for 4/17) to avoid the hassle. Maybe your company is self-pay also? They would never advertise that to the employee population, but being in HR I sat in on the meetings.

It's frustrating, but many companies don't cover wls because it's $$$. Appeal it..it'll go to Sr. Mgmt and they will decide. They will not know who you are- just that X employee in X dept requests X for X reason. If they reject again, Appeal it again.

Sometimes though, companies do not have an appeal process in place for things like that. Find out from your corp. HR team. At my company it would be covered, but they'd know who I was because..i'm the only fat one in hr!! I don't want them knowing my business...

good luck!

Well, according to my doctors office, if my job didnt have these extra requirements, UHC was going to approve the surgery...which makes it ever MORE frustrating. I have a contact at corporate that I'm waiting for a call back from. I still have a feeling this is going to get dragged out all over the place....fingers crossed though!

Well, according to my doctors office, if my job didnt have these extra requirements, UHC was going to approve the surgery...which makes it ever MORE frustrating. I have a contact at corporate that I'm waiting for a call back from. I still have a feeling this is going to get dragged out all over the place....fingers crossed though!

I know, it sucks. Make sure you're talking to the right person though...someone in benefits...and if they do not call you back within 48hours email the HR Director.

You want to ask them if they have an appeal process for WLS. They might not answer you directly so ask them to refer you to the page in the insurance coverage booklet where it describes the process for WLS. HR should never take more than 2 days to get you an answer.

Good luck!

Maybe your company is self-pay also? They would never advertise that to the employee population

My company is self-insured and they do advertise that. They ask us to do things to stay healthy, so our costs are kept down. Which is why I'm :thumbup: that they exclude WLS as it's the best thing I can do to be healthy.

I am working on a letter that explains that they spend so much on my blood pressure and other meds now that WLS would actually be cheaper in the long run. I've been there for years and will most likely be there at the break even point so it really is worth it to them.

They will not know who you are- just that X employee in X dept requests X for X reason. If they reject again, Appeal it again.

My dept. is small enough that it would be pretty obvious who it was. But that's okay. I don't care if they know because I think it's WRONG to exclude this surgery and I'm willing to fight them about it.