Hi everyone!

I went to my first appointment today and found out my insurance requirements (I have United Healthcare Choice Plus) -- 40 BMI or 35-39 BMI with two comorbidities, and 5 year health history with 40 BMI. Today when I weighed I was at 40.5, and I know I was not that high through the last 5 years, although I am sure I was above 35.

The only comorbidity I have is hypertension although they told me the insurance might not count it b/c I am not on meds. I am scheduled for a sleep study which might diagnose me with sleep apnea.

Anyone think I have any chance of getting my insurance to approve? Thanks!

They paid everything after except my $1,000 max out-of-pocket. The one thing to watch for is out of network providers I had one and it took awhile to get that paid they paid part of it and that provider took that as full payment but I almost had to pay $2,000 for that one.

When I went to the seminar a couple months ago the surgeon group was considered out of network but they weretrying to get put as in network thru UHC. I called the surgeon group the other day and they said they were now "in network" as of Dec. 1st.

Has anyone had their surgery @ St. Marys and Elizabeth hospital after Dec. 1st, 2009? I called the other day and they said they are now considered "in network" with UHC. I'm not sure if I am understanding this right. I wonder if since they are "in network" if you would have to pay the $4000 up front before the surgery? I'm going to call them on Monday again to ask.

I just heard from St. Mary's and they said that UHC is going over their 2010 benefits and I should hear something by next week.

Has anyone had to put in an appeal with UHC? My husbands surgery was back in June 2009 and after appealing they are still denying out entire claim even though we were told by our doctors office that we were approved for the surgery. Has anyone had any bad experinces with UHC and can you offer any advise on how we can maybe fight this?

It is amazing to me how you can get approved for the band and then they back away. My wife and I have had the band for 2 years now, and she had an adjustment last June and we are still having issues with UHC to pay the claim. They are saying the doctors office did not send all the information as to why the adjustment was done. I sent a letter to my employer, insurance commission, doctors office and to UHC. Hope to find out something soon.

Chris

I am having the toughest time ever with UHC... First they said my employer won't cover it. Then I called them again and said they would open a case file for me and would call me within the next 5 days. After 5 days I called them and they claimed they never opened a case but they would do so now and to call them back within a week. A week later I called them and they said they're backed up and I should try again next week...

AHHHHHHH!!!!

And judging by all the hoops I've heard they make you jump I am almost tempted to pay out of pocket. ALMOST. But who has that kind of money??

Does anyone have tips or tricks on how to deal with them??

It is amazing to me how you can get approved for the band and then they back away. My wife and I have had the band for 2 years now, and she had an adjustment last June and we are still having issues with UHC to pay the claim. They are saying the doctors office did not send all the information as to why the adjustment was done. I sent a letter to my employer, insurance commission, doctors office and to UHC. Hope to find out something soon.

Chris

So did they just say the fill wasn't covered? I was banded in October '09 and I just received a bill from my Doc's office stating that I owed them $550 for the fill (plus I had another one since then, so basically I'm going to owe them over $1000?)....when I called UHC, they said that it's not that the fills aren't covered, it's how they are trying to bill it and that it's part of the global service - what does that even mean? They can't expect that because they paid a whopping $900 for the surgery (yep, that's all they paid the surgeon), that I would get lifetime fills for free, right?

So did they just say the fill wasn't covered? I was banded in October '09 and I just received a bill from my Doc's office stating that I owed them $550 for the fill (plus I had another one since then, so basically I'm going to owe them over $1000?)....when I called UHC, they said that it's not that the fills aren't covered, it's how they are trying to bill it and that it's part of the global service - what does that even mean? They can't expect that because they paid a whopping $900 for the surgery (yep, that's all they paid the surgeon), that I would get lifetime fills for free, right?

Hey HDmama!! I am in the medical field and have been doing medical billing and collections for over 20yrs now and to answer your question when they say it's included in the global primary procedure.........you fills are at no cost to you. When the dr signs up with an insurance company and they sign a contract they agree to accept whatever is in their contract with each individual insurance compnay. The CAN NOT bill you for the fills when the insurance company denies it as "Included In The Primary Procedure" It the office tried to bill you for this then you contact your insurance company an have a rep call the dr. office to explain them how to correct their bill/or correct their billing process. I hope this has helped you out some. Any other questions youmay have on the billing nature feel free to ask me ~Smooches~

hi babydiva, i am new to this blog. i was going to have the lap band last year but didn't because i thought i could lose it on my own. well, i haven't. we are the same weight. i want to weigh 140-150 too. could you let me know how your surgery went and weight. i plan to have the surgery. i have everything complete just need to turn paperwork in at meeting.