New insurance - no coverage

[jbhedge2 0]

I was banded April 2010 and had BCBSNC coverage thru the end of the year. My company has switched to UHC and my Bariatric office went to pre cert my fills and was told there is no bariatric coveage with my plan. Am I out of luck? Is there a chance that if I appeal it I can be covered. Looking for others that may have gone thru this and what steps I should take... Very upset today. Thanks Jayne

[honk 780]

I would call the health insurance myself. If the new policy does'nt cover fills you can't really fight that. The employer determines what they will and won't cover in the health insurance. What I would do is speak with the billing dept off the hospital or doctors office and see if you can negociate a cash payment price. If you look at the statement of benefits from your insurer they normally say billed cost of service $300, negociated rate $50, amount paid to provider $50. I would look at past bills to see what your insurance actually paid for the fills and tell the billing dept you want to pay what they were accepting from the insurnace company. You could tell them you will pay for service up front by credit card so that they know they will get the money. You may be able to save a lot of money that way.

[spoiltmom 44]

Those are all good ideas. Also check with your HR department. They can tell you if your employer for sure dropped bariatric coverage.

[Rchavez101 0]

I am in the same boat. I had BCBSAZ and had surgery Nov 4th. We now switched over the UHC. Well the hospital doesn't take the new insurance. The one thing that my company worked out with UHC was to have "Transition Care". UHC will cover me for 90 days as if it is in network. After 90 days I will be on my own. IT sucks because they are the only ones in New Mexico. I will have to be a selfpay for fills. They are $350 and that is a little steep but I have no choice.

You should find out if you have the option of "Transition Care" in the policy. Check with you HR rep. Good luck.

[honk 780]

Rchavez101 I would try to work out a cash payment price as mentioned above. Also if you are at the begining and will be getting multiple fills you could see if they will agree to a block pricing: so 5 fills for at $200 a piece instead of $350. Again you could say that you'd pay the $1,000 up front. Also if you have Medical spending account through your employer you should be able to pay for these medical treatments using that money. Remember medical spending accounts are pretax so you are saving at least 25% in tax burden.

[Nelsonn 0]

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[jbhedge2 0]

Thanks to all that replied. All good pieces of advice. I went to my HR and she is looking into it. Says she didn't realize they didn't offer it... My bariatric office is getting the appeal paperwork and I will go that route, also...

If needed, I will try to negoiate being a self pay patient...last resort!!

I need my band and need the support and help from my docs and fills!!

Nelsonn, I have no clue what your post was about ....

Happy New Year to all!