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

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.

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.

Hey, i have an idea. Typically they like numbers. So, why not list your monthly expenses that they cover (doctor visits, meds, etc) and then show them how it would be reduced in the long run $$ wise.

It's cheaper for the company to get the insurance for it's employees if they get the WLS exclusion. It's not so much that they are "denying" you as it is that they got the cheaper insurance package. Sorry you're having to go through all this crap!

I have UHC too and its my employer, not UHC that has denied me. The reason is "its too expensive to add into the policy. It would raise your rates way too high." This from my HR dept! Have they looked at all the walking heart attacks waiting to happen when I work??? HR put an exclusion on WLS so it won't do any good to appeal. Plan B is that I am a veteran so I am going to hook up with a VA center thats about 2 hours from where I live and see where that takes me. Wish me luck!

Hey, i have an idea. Typically they like numbers. So, why not list your monthly expenses that they cover (doctor visits, meds, etc) and then show them how it would be reduced in the long run $$ wise.

I'm working the spreadsheet right now. :rolleyes2:

Wow. That is just insane. I would seriously appeal to them about what a good employee you are. And also, I would be pulling up every last stat you can find about morbidly obese people having more sick days than normal BMIers (Seriously...I've heard this). Do they really want to risk losing an employee to an obesity-related illness because of such a silly requirement? On top of that, you'll most likely end up costing them LESS in the long run because people of a normal BMI tend to be healthier (I.E., less doctor visits). Oh, you can so fight this. Fight the good fight, girl - you can get past this. If they seem to be unhelpful, I would seriously consider talking to an attorney (at least a free consult) to see if they can even DO that. I don't get how the heck they can do that.

As of Thursday my plea to waive these extra requirements went to the highest level of whatever part of the benefits department at my job...just waiting to get an answer back....fingers crossed!!! I'm surprised at the amount of support I'm getting from the people at corporate. Everyone is on my side...unfortunately I don't know where things stand with the people that matter...

As of Thursday my plea to waive these extra requirements went to the highest level of whatever part of the benefits department at my job...just waiting to get an answer back....fingers crossed!!! I'm surprised at the amount of support I'm getting from the people at corporate. Everyone is on my side...unfortunately I don't know where things stand with the people that matter...

Fingers are crossed! Good luck and keep us posted.

Hey Sahm of 3

What if you offered to pay the difference to "upgrade" your policy to include WLS. For example if the company is paying $200.00 per month for your current policy, and the 'upgrade" policy costs $255.00, you could propose the you would pay the $55.00 difference. This way you can get you WLS for virtually nothing, and the company does not incur extra expense for you and the other employees. Might be worth a try! Good luck

Good luck Kimmie I am going to be praying for you, it hard enought the insurance gives us a hard time,now you have woory about your employer:angry_smile:

So---if I have UHC, but there is an exclusion for WLS, is it possible to fight it?

So---if I have UHC, but there is an exclusion for WLS, is it possible to fight it?

I depends on if the exclusion is actually part of the UHC plan you have or if your employer made the rule....like mine.

Ok, WELL...it's official....my job completely denied my request to waive their special requirements...so I'm cancelling my insurance with them! Now I have another question....

I currently have UHC. If I cancel my current UHC plan, will I ever be able to purchase a UHC plan on my own and get approved for the band surgery? Is all of that null and void? Will I have to completely re-test again??

Initially UHC was going to approve me because of my BMI being so high (even though I had no co-morbidities), it's just my employer's extra rules that screwed me. Will they see all my previous claims for the testing/lab work that I've done and deny me because I look unhealthy now? If there's anyone out there that understands what I'm saying, please help...thanks in advance!!!!

Just some food for thought -- think twice before you cancel your in-force UHC coverage. I think you mentioned already being told this, but picking up a private pay policy can be hard to do when you're obese, have existing health issues, etc. When people can actually find a carrier, they often learn it's more expensive than they would have ever thought. More info in my 3rd paragraph.

Answering whomever asked this (I don't remeber now) -- you can't really fight an employer-enforced exclusion because there's nothing to fight. They opted out of some options to save money, that's all it is on the business end. There's nothing there to fight because it's like asking for something from UHC that no one is paying for or agreed to purchase. Really the only thing you can do with an employer-enforced exclusion is ask the company to make the exception. BUT, they can't just make an exception for one person. With group coverage everything has to apply to everyone, except for MAYBE cases of extreme disability. MAYBE. And this wouldn't be one of them.

Kimmie - you will probably have to start from scratch. This is because UHC doesn't sell "X insurance product" it sells many, many different products. My company has UHC as one of the insurance options, and I think we have 9 plans to choose from - and that's not even the tip of the iceberg. Sometimes they will sell package deals (like a gift bag that's already assembled), sometimes customers (you're not the customer, your employer is) can pick the individual items to make their own gift bags but that's increasingly rare because of the cost. On top of that, each plan can have completely different requirements for approval, testing, facilities, etc. So being approved with UHC "plan x" doesn't mean you will be approved with plan y, z, a, b, c, d, e.... nor does it mean approval requirements, coverage rates, copays, OOP maxes, etc. will be the same.

I do understand what you're saying -- I hope this makes sense. :thumbup:

Wheetsin- Thanks so much for the info...it does make a lot of sense. I know I was told that cancelling my employer offered insurance may not be a good idea, but luckily, I'm currently on a contract job. We're on contract for a year, off for 100 days and then hopefully back on after the break. I think on my break, I'll be looking for another job with another insurance plan that way....it seems like the only way around it.

Edited March 25, 200818 yr by Kimmie K

If you work for a large company, employer-enforced exlusions are pretty firm. If you work for a smaller company, and could "rally" enough others who would be interested, and petition the employer from the perspective that there are a lot of us and numbers matter, then maybe you'd be able to make some headway. But employers care about bottom lines and ROI so you'd need to be prepared to back up your request with numbers. However, since you are a contractor on part-time (annual) basis, I'm guessing you work for a mid-large employer.

Do they offer other plans you could choose from, perhaps one that doesn't have an exclusion, and then switch over during open enrollment?