UMR/UHC Options PPO Question

[Scooterbug 13]

My wife is about to sign up for her new insurace now that it is open enrollment time. We are both looking to get Lap Band and was wondering if anyone could answer a few question for us.

So far she has gotten only a small amount of info regarding her options (basically a 5 page print out of information so far). On the print out it says:

Gastric or Intestinal Bypass

Maximum benefit per lifetime: 1

also on another page it states:

Morbid Obesity Treatment

1) If it states 1 under benefits per lifetime..does that mean only 1 of us would be able to get it..or does it mean 1 per person?

2) What would Modbid Obesity Treatment cover..as in how is it differnt from Gastric/Intestinal Bypass or Lapband?

3) Would this cover Lapband? (It doesn't show Lap Band on the small amount of info she got...and I don't want to ASSUME it's covered)

4) Has anyone had any experience with the UMR/UHC plans? If so what are the BASIC requirments?

[Grider 92]

My wife is about to sign up for her new insurace now that it is open enrollment time. We are both looking to get Lap Band and was wondering if anyone could answer a few question for us.

So far she has gotten only a small amount of info regarding her options (basically a 5 page print out of information so far). On the print out it says:

Gastric or Intestinal Bypass

Maximum benefit per lifetime: 1

also on another page it states:

Morbid Obesity Treatment

1) If it states 1 under benefits per lifetime..does that mean only 1 of us would be able to get it..or does it mean 1 per person?

2) What would Modbid Obesity Treatment cover..as in how is it differnt from Gastric/Intestinal Bypass or Lapband?

3) Would this cover Lapband? (It doesn't show Lap Band on the small amount of info she got...and I don't want to ASSUME it's covered)

4) Has anyone had any experience with the UMR/UHC plans? If so what are the BASIC requirments?

im not sure of that insurance but by pass is not lap band,, an if both covered that mean each one.. see if they do lapband?

[MelindaH 3]

My wife is about to sign up for her new insurace now that it is open enrollment time. We are both looking to get Lap Band and was wondering if anyone could answer a few question for us.

So far she has gotten only a small amount of info regarding her options (basically a 5 page print out of information so far). On the print out it says:

Gastric or Intestinal Bypass

Maximum benefit per lifetime: 1

also on another page it states:

Morbid Obesity Treatment

1) If it states 1 under benefits per lifetime..does that mean only 1 of us would be able to get it..or does it mean 1 per person?

2) What would Modbid Obesity Treatment cover..as in how is it differnt from Gastric/Intestinal Bypass or Lapband?

3) Would this cover Lapband? (It doesn't show Lap Band on the small amount of info she got...and I don't want to ASSUME it's covered)

4) Has anyone had any experience with the UMR/UHC plans? If so what are the BASIC requirments?

[MelindaH 3]

You would be eligible for the procedure as long as you purchase dependent coverage. If WLS is a covered benefit, the lap band should be covered as it meets the standard of care for bariactric surgery.

The rest you are going to have to get from the ins company or your wife's HR.

I have heard of some aggravation with UHC plans. They do have a strict protocol that you will have to follow to qualify for the surgery.

Good luck on your decisions to improve your health.

Melinda

[Scooterbug 13]

Thanks Melinda,

My biggest peeve at the moment comes from lack of information from my wifes HR department and UMR.

Her HR simply sent there employees a short email alerting them of open enrollment. My wife had search for a couple hours on there internal website and she found only a small bit of information (printed out it came to 5 pages..just saying what was covered, co-pay, coinsurance %, etc).

My wife contacted her HR person and they refered my wife to call the 1-800 number for there main HR person..since she didn't have any information on the insurance. The main 1-800 told her the same thing, that they didn't have any information...and they refered my wife to call UMR. Well upon calling UMR my wife was told they couldn't help her unless she was ALREADY enrolled in the insurance plan..then they told her to call her HR department.

So far from what we DID find..some type of bariactric surgery is covered. As far as the requirments we are still in the dark. Was trying to get as much information as possible before we got our hopes up.

[mayslindabillups 0]

Yes its covered. Ask the ins company to send you the exact details on what's needed to be approved. Two years with the company. Six months with nutritionists psychology PT BMI over 40.

[Scooterbug 13]

Yes its covered. Ask the ins company to send you the exact details on what's needed to be approved. Two years with the company. Six months with nutritionists psychology PT BMI over 40.

My wife and I have already started the process (about 3 months ago), so we are moving right along.

My question is: What is that "Two years with the company" thing all about??? I never heard anything about this at all.

[mayslindabillups 0]

I have UMR in wisconsin through my employer. When I asked for all the requirements for lapband they sent me a packet. The first thing I read at the top of the packet stated that I must have 2 years of continued employment with the company to recieve this covered benefit. I have been with the company for 4 years no problem their. My BMI is only 38 and i have GERD and back pain.

[ready4changein2011 70]

I have UHC ppo options and they required the 6 mth supervised diet, pych consult, Bmi >40 or 35 > with 1-2 comorbids, letter of medical necessity from pcp, must be performed at hospital. The rest of my requirements were physician based. Good luck.

[Scooterbug 13]

I have UHC ppo options and they required the 6 mth supervised diet, pych consult, Bmi >40 or 35 > with 1-2 comorbids, letter of medical necessity from pcp, must be performed at hospital. The rest of my requirements were physician based. Good luck.

That's exactly what my wife's plan requires of us as well. My physician required Cardiac, Anesthesia , and sleep consults as well.