Hello I am KEKE 42 and about 8 mths ago I started the process for getting a gastric sleeve. I called my insurance UHC which at the time told me that normally this isn't covered but if I meet certain criteria I could be. BMI over 40(check), high blood pressure, sleep apnea, tried every diet , and pill supplements prescribed and over the counter( check).
So I had to do 6 months nutrition visits- which I completed without a hitch 2 months ago. Now time for the preapproval call- before the office could get a word out they just flat out said not covered.
I was baffled at this because this is not what I was told at the beginning otherwise I would have figured something else out and not have gone through this whole process to be just told no. There was no official denial so I can not appeal , they just said not covered.
Apparently this has happened to many other members, by being told yes at the beginning to be told differently at the end. Not only am I a member of UHC I also work for UHC. So now it has become apparent that the reason for this "not covered" is because UHC doesn't cover the surgery for employees. I was like what!! That is the stupidest thing ever.
So now what do I do? Ive considered looking for another job, I was actively looking, but my luck as soon as I leave then it would be covered for employees. I don't qualify for Medicaid as a secondary.
I need assistance on getting my surgery approved or guidance to a secondary insurance company that will cover WLS in CT, Loans are not an option nor is paying out of pocket.
I know I need to wait for open enrollment but I just need to know the best insurance company to apply for when October comes around.
Thank you all for any input