EMPLOYER/UHC Excludes LB!!!

[lookg4me 0]

I CAN NOT BELIEVE IT! I HAVE CALLED MY BENEFITS UHC LINE AT LEAST SIX TIMES DURING THE PROGRESSION OF GETTING MY BAND. THEY HAVE PULLED UP MY INFO 500 X AND NOT ONCE DID THEY MENTION "OH YEAH YOUR EMPLOYER EXCLUDES THE LAP BAND!" NOT ONCE! I am so frustrated. My employer does however cover the gastric bypass. I DO NOT WANT MY ORGANS REROUTED, AT LEAST NOT RIGHT NOW, I WANTED TO TRY THE BAND FIRST. I have spent many an hour since the investigating of this procedure reading up on everyone's highs and lows, what to expect, I've been to the seminar and to my first doctor appointment. I am so let down. I just really don't see myself going through the gb. SO DISAPPOINTED...

[lookg4me 0]

:help: :embarassed: :sick :angry :huytsao :phanvan :faint:

[Alexandra 55]

You know, I've never heard of an employer having a restriction like that. Why would your employer want to decide which surgery you have? I'll bet that's a mistake, somewhere along the line. It may even be discriminatory or illegal. It's one thing for an insurer to have preferred treatments; presumably those decisions have been made by the doctors on the carrier's medical review board. But assuming your employer doesn't have a medical review board, it shouldn't be making those decisions.

This just sounds wrong all the way around to me. Talk to your HR department, counselor, advisor, whatever. Make noises like you think this is a discriminatory rule and ask if you can appeal it. Let them know you might be seeking legal advice. That should get their attention.

[lookg4me 0]

I called uhc when I got home today and after being hung up on (presumably by accident), being sent to bogus departments, being placed on infinite hold. They told me that the exclusion is based on excluding morbid obesity surgeries that are considered especially dangerous?? I'm sorry but rerouting my esophagus to my big toe sounds worse than banding an area of my stomach! Which is reversible and adjustable!!

*&%$!!!! I then asked them if they could email me whatever they were reading to me because the exclusion are not listed anywhere on the website when I enter my own personal info. They then sent me to the bogus dept, who was clueless as to why I was sent to them, THEN I called back a couple more times for them to tell me that the only way to know about the exclusion is to have them mail it to me. ?? So I will have to wait a week to even find out IF they actually are mailing me something, and then to try to decipher what the exclusions are! UGHH

[kim2bhealthy 3]

lookng4me - Do you have a copy of your subscriber agreement or policy? Any exclusion should be clearly stated in there... If you don't have a copy go to your compnay's HR person or Insurance person.. They should definetly have a copy...

[gviscio 0]

Covering the bypass and not the band is actually common, and there are two reasons. One is that the plan or employer just renews every year and no one really looks into it because they just don't care, or the other is that they do it intentionally because they know many people don't want to be re-arranged internally.

About two years ago the carriers started covering open bypass instead of lap and the word was they were going to make that more widespread. They said it was safer but the real reason was because most people were now applying for it lap and not open. Open scared them away.

My feeling. Nothing is done on accident. Good luck

Gary

[amus71774 0]

UHC is an awful company. I have them right now and the process that I have been going through is just so time consuming. It got to the point where my surgeons office contacted me to get involved. Over the past two weeks I have called them every day and like you have been sent to different departments, nobody knows anything and I can't get a straight answer. Apparently, my doctor's office has sent over my clinical package via Fax and mail 8 times and it was never entered into the system. It has been over a month now and still nothing. Can anything ever go easy? Good luck with things.

[marz88 0]

I find all this talk about uhc disturbing. In my area, they are about the only insurance company that will pay for the band. I think so much depends on your employers policy with them. My friend and I are both uhc but with different employers. We started the process at the same time, our requests for the surgery was actually sent on the same day. But she was approved a month before me! And get this, the same doctor is doing both surgeries, but he is considered "out of network" on my insurance. So, I get to pay more for mine than she does. Doesn't make much sense but I'm glad it finally came through and I'll be banded next Thursday.

[Flutterby2b 0]

I used to work for UHC. I was an Inpatient Care Coordinator and also worked on a Dedicated account. I learned that all the different employers that contract with UHC for medical coverage can choose different plans and what will be cover and not covered.

Alot of employers will select a contract that covers the surgery- but you have to jump thru hoops..ie , prove 5 yrs of being over wgt, 2 yr of Dr supervised dieting, at least 2 other high risk factors ... ie diabetes, high blood pressure, heart problems psyc evaluations, and diet consults only a few of the things that may be required.

Just recently, employers have been given the option of covering Gastric bypass and not lapband (BOO Hiss).:frusty:

Then you have employers that will choose contracts that say either surgery will be covered if the pt meets that National guidelines: BMI above 40 or BMI above 35 if other high risks. Over wgt fdocumented for 5 years etc...

Please be aware- it's not just UHC.. it's also your employer that makes that decision when they make a contract with UHC.

By the way- UHC does not cover their own employee for any type of wgt loss surgery: gastric bypass or lapband.

I was luck that I had coverage thru my DH's insurance with UHC. They happend to be an employer that said you only had to meet national guidelines. After 9 mos of research, lerking on this board and others, going to 8 different Doc's to see if I likes any of them. I decided on the lapband. I wouldn't change a thing. I would do it over again in a heart beat.

I no longer work for UHC. I'm now on the other end doing Clinical Appeals for surgeries/procedures/hospital days deemed not medically necessary. Boy have my eyes been opened, I've learned that what is actually "authorized" may not actually be covered if you employer has it excluded from your plan. I spent 12 years doing precertification for Cigna and UHC - and we ALWAYS gave the disclaimer "This is not a guarentee of coverageor benefits, please check with your benefits to make sure this is covered" Now I really know that that means.

This means READ THE FINE PRINT when you sign up for your health insurance annually. If you don't have the actually contract, ask your HR depart for that contract to review.

[lookg4me 0]

Gastric Bypass. Not wat I wanted to be approved for, and I'm scared to death of gastric bypass. I guess being scared OF death is why alot of us are doing what we are. I'm so conflicted right now... Anyone dealt with this similar instance...Thanks guys! xoxo

[Nana~ 4]

UHC PPO approved me for band in 30 days and I had 20.00 copays for my fills. Unfourtunatly now I have aetna and the dont pay crap

[Cmstant 0]

Looking for someone who does fills in the Houston area that will accept UHC... I Had an appointment to see him tomorrow, but a nurse called and said it will cost $100 for a fill? Now I don't know what the going rate is but this sounds expensive to me especially since I have been paying $10 a fill. Any info will help.

[mommy2kai 0]

I'm having a the exact same FRUSTRATING experience with my employer and UHC! UHC told me three different times that our plan covered both Lapband and gastric bypass. I was over the moon! Then, at the request of a dr, I contacted my HR department to get a copy of our policy in writing, to verify that it was covered. Imagine my shock when they told me that not only does our policy not cover it, they have very carefully written the clause in the policy so that they will never cover it. I guess they would rather have me fat and on a ton of meds or with several co-morbidities than to pay for something that would make me healthy.

Right now, self pay is not an option; we can't afford another bill. Looks like it's back to Weight Watchers and another stab at that. :cry

[sproutwife 0]

If it makes you feel any better I am almost in the same exact boat as you. I have UHC through Compass Bank. I too was told by UHC several times that the band would be covered and was elated. I went to see the surgeon on January 31, waited until February 21 for the doctor's office to submitt to UHC and was told repeatedly that they had the info at UHC and I would be getting a reply within weeks. Well, UHC claimed everyting was in order until March 31 when they decided that they did not have enough supporting documentation. They on April 1, my doc's office resubmitted the paperwork to UHC, only to be declined on April 14. I was declined because Compass Bank has an exclusion in the healthcare policy stating that you have to have a BMI of 40 and a co morbidity, but not just any co morbidity. They have a list. And I don't qualify. I'm livid.:angry

[FunnyDuddies 6]

uhc is helping new companies, and renewal companies to write in this policy. they are carefully and slowly backing away from the weight loss surgery game.