Insurance Covers , But Employer Excludes?????????????

[krysmaslily 0]

I just heard from my surgeon's nurse today and she said that United Health Care (my insurance) covers the band but my employer excludes it.

I don't understand. She told me it would be worth it to call them and talk to them about it. Is this common? What should I do?:help:

[Alexandra 55]

Large companies negotiate their own health insurance contracts with carriers. If your employer has carved out bariatric surgery, they might be able to make an exception or even purchase a rider that puts it back in. Obviously you'd have to discuss this with your employer, since it's part of their contract with United Healthcare.

Who told you to call who? The place to call is your human resources department and see if there's an appeal process or any way to petition for an exception. Good luck!!

[krysmaslily 0]

Thank you so much for the advice. I plan to tackle this immediately. I will let you know how it goes.

[Showbiz 0]

Hi everyone. I'm new here, but wanted to jump right into the discussion. I just discovered this forum last week.

I too am desperately trying to find a way to get insurance to cover the surgery. My employer excludes this clause to keep cost down. I asked them to consider purchasing the rider, and they were very open to the idea and wanted very much to help me. Unfortunately the rider costs 52,000, and by the time our contract is up for renewal it will be close to 60,000. So...needless to say, they won't be able to help me out with that one.

I'm at a loss. I'm ready to do something and I just can't find a way to overcome the financial burden.

<sigh>

Shannon

[Elisabethsew 50]

A lot of companies are excluding weight loss surgery and usually won't change their policy for one person. Also, contracts come up for renewal once a year so you'll need to find out when the next enrollment period is.

[Wheetsin 714]

Unfortunately if your employer excludes, then it's entirely their call whether or not they alter the policy or purchase the rider. Most of the time they won't b/c of cost (which is usually why they implement the exclusion anyway).

Something else you could ask while you're at it is, if you have your choice of coverages, are there any which they haven't placed an exclusion with. E.g. we have something like 11 healthcare coverage options, with about 7 different companies. If there was an exclusion on option #1, maybe there wasn't on option #2, and so on. Likely not, but worth asking.

[babiepearl22 0]

im just wondering how to get tricare prime to cover the surgery, has anyone had tricare cover theres recently

[NurseTeresa 0]

I also have ran into the same problem with United Health Care. I work at a hospital that does the LB and the RNY. However, our insurance has an exclusion. We have appealed to our HR dept with no avail. It seems so unfair that a hospital will do the surgeries but not include them in our policy. We were told in May that it would be included by October. I sat in surgery today watching a RNY be done and was told by the Drs. and the bariatric coordinator that the hospital has decided that it will not be included in October and that so far 60 people have appealed the HR dept. All with no luck. They also stated that it will more then likely not be an inclusion when the insurance is renewed with the next renewal date. So I can feel your pain. If you come up with anything exciting please pass it my way! I will do the same! Good luck to everyone with their insurance endeavors.

[dpingl 0]

This is really ODD, I have United Health Care through my job Yellow/Roadway and I am amzed how easy it was to get approved. One letter 3 weeks later I am approved with a BMI of just 40... no dieting, no meetings, nothing. Approved.

[kittylover 1]

I have a BMI of 44.4 and my insurance (United Healthcare POS) denied me today. I contacted obesitylaw.com to help me.

[blaire576 0]

Sometimes insurance companies (i.e. Geico, Progressive) that insure you over the phone will give you an INITIAL quote, which sounds pretty good. But then they'll look up your record and that quote will change. So be sure the prices you're getting are the exact price you're paying when you sign on that dotted line, you could check insurancepaylite.com Like a good neighbor, they'll give rebates to their customers if claims are down for a given year.

[ericsmom 2]

I used to work at a non-profit organization. They had a plan with a company that did cover it, but the plan excluded it. The best way they explained it to me is that my employer had the "Ford" plan and in order to have the surgery they needed the "Cadillac" plan. I petitioned my employer to ammend their plan to include this coverage (I was persuing gastric bypass at the time) and they would not do it. They were afraid it would start a "trend" in the company.

I left that employer a year ago and work for our local school district and my banding was definitely covered

Good luck to you as you seek your funding source...

[gonnabethin 10]

Its all about "carve outs" and cost. Too expensive to cover, however if Obesity ever gets classified as a disease like alcoholism or depression or heart disease then it will be covered- HOWEVER expect premiums to sky rocket. As long as a company can decide their exclusions they can control the costs. Once they are no longer able to do that it will be passed to the consumer!! Insurance is BIG business and the insurance companies are currently in the drivers seat!!