United HealthCare

[Bullwinkle 1]

I keep reading posts on these boards about insurance, and the need to document the information I get from the insurance company. I just scared that they will deny me due to "pre-exisiting condition."

Thursday, 11-02-06, 6:30pm, I called the toll-free number on the back of my husband's UHC insurance card. After pushing a few buttons to get through to customer service, I talked with a man named LeLand. I asked him this question (straight from the paperwork supplied to me by Dr. Curry): "I am inquiring about my policy benefits on surgical weight loss. Is surgery for morbid obesity a covered benefit? In particular, I'm inquiring about lap-band surgery.”

LeLand: "Yes, it is. Lap-band surgery is a covered benefit."

Me: "May I please give you the code for this procedure and would you please check to see if this particular code is covered?" I gave him the code.

LeLand: (After sighing and acting like I was a pest) "Yes, that code is a covered benefit."

Me: "What information do you require before approving the surgery?"

LeLand: "You have to have a BMI greater than 35."

Me: "What else?"

LeLand: "Ma'am, just have your doctor's office call our care coordinator and they will work out the details. This procedure IS covered by your husband's insurance policy."

At that point I just thanked him and hung up because he acted like I was just a huge pest. What I SHOULD have done was stay on the phone and gotten all of the information from the paperwork Dr. Curry supplied to me.

Now I'm scared that if I call the insurance company back, I'll "tip them off" that I want to have this surgery done, and they won't put me on the policy. My husband just enrolled me this past week, and I won't be effective until 01-01-07.

Any suggestions? Should I call them again and get more specific? If I do, won't they think this is considered a pre-exisiting condition, and can't they deny me in January?

[Alexandra 55]

Hi Bullwinkle,

If you're being added to your husband's policy during open enrollment, then in general, pre-existing condition exclusions don't apply. Rules vary from state to state, but whether you're enrolled and whether they cover the surgery are really two different issues.

You already have the information you need, so there doesn't seem to be a good reason to call the insurer back. Wait until you're actually ON the plan, and then call and pester them to your heart's content.

I'm not saying this because they might not put you on the plan--I doubt VERY MUCH that's a decision they can make based on your health--but because until they are talking about a specific person and medical situation there is little the carrier will tell you "for sure." I'm an insurance broker and know from experience that until we're talking about some specific covered individual I won't get anywhere with a carrier rep.

[Terrilen 0]

If it is any comfort to you I have UHC (standard conversion policy) meaning I pay for it. Let me tell you they have covered EVERYTHING to do with my Lap Band! They even cover my fills! So think positive and good luck!

[Bullwinkle 1]

Thank you for your replies! They are very helpful. My husband's UHC insurance is through Hewlett Packard -- a large, large group -- and I've gone to www.muhc.com and have looked up information that pertains to his policy. They even cover "domestic partners" (same-sex unions) for medical insurance. They are very liberal in that regard. MY UHC policy -- for a VERY small group -- doesn't cover much at all. So, there ARE vast differences in UHC policies. I suppose it all depends upon your group and what your employer is willing to cover.

Again, thank you for the information -- and for the PM's (you know who you are ) -- and I will let you people know what UHC says when it's time.

Now if I can just hold out until my initial consult with Dr. Curry on Wednesday. I am SO hyped!

[need2bhealthy 0]

HI THERE!

Please let me know what you find out. I have UHC through Sun Microsystems. We are changing to Blue Cross Prudent Buyer very soon but I have been holding off so afraid I can't afford the Lap Band.

My BMI is 37.5 and I have no other health issues so that is the grey area.

Good luck to you on being a BIG LOSER

M

[alcon 0]

I too have UHC through my husband. I called them yesterday to find out if there were any restrictions and I was told it was covered 100% but there were guidelines and forwarded me to the appropriate person. Well, this individual was unwilling to give me any information except have my doctor forward my information. I was a little discouraged. I have found with my personal experience w/UHC in the past, they have great coverage but everytime I call the customer service I get frusterated!!!!!!!! Good luck.

Also, I really don't think they would deny you. Like Alexandra stated if you are enrolling during OE pre-exsiting does not apply, at least in my experience it does not.

[Bullwinkle 1]

need2bhealthy - while at my consult, I met with all four team members and the Insurance Coordinator told me tht I'd have no problem whatsoever being approved for this procedure with my husband's UHC coverage. She said that they are a DREAM to work with. Also, I was a bit nervous that UHC wouldn't cover me because I didn't think I had any of the co-morbidities everyone talks about. Well, I wsa wrong. I have high cholesterol -- managed by meds -- and asthma flare-ups -- managed with an inhaler -- and she told me that those ARE co-morbidities. In either case, my husband's UHC coverage doesn't demand that I have any of those, anyhow. Read on....

alcon - when I called my husband's UHC customer service, I asked if the lap band were a covered procedure, and he told me that is was. I asked if I could give him a specific code and, after sighing and acting like I was a bother, he looked up the code and said, "Yes, like I told you, it IS covered." I then asked what the criteria was for being covered and he said all I hafta have is a BMI greater than 35. I was surprised and stated such, and he again acted like I was being a pest and told me to have my surgeon's Insurance Coordinator contact them, and they'd get everything worked out. I, like you, hung up the phone feeling somewhat frustrated and felt as if I were being dismissed.

So, since I won't be effective on hubby's insurance until 01-01-07 -- and since I've had every reassurance from both the surgeon's office and the insurance carrier that this will be a covered procedure, I'm going to try to quit worrying about it.

[avilla 1]

I have UHC HMO...And when I went to my seminar for the surgery the nurse told me that UHC is the best one to work with for lapband surgery...I didnt have to have any medical condition to be approved..It just relied on my bmi which with my plan had to be over 40 and you were automatically approved...I only had to pay my copay for my surgery and havent had to pay a thing since including my fills...I have heard thru the grapevine that the fills are only covered for the 1st year...I might work up the courage on my next fill next friday to actually ask the nurse to find out for sure...But I have been trying to get in about every 1 1/2-2 months for fills anyways just incase...I want to be at a comfortable good restriction by then because I cant afford the fills after that...But I have been very pleased with UHC...The only problem that they gave me in the beginning was the cost of me stepping on the upgraded scale at the office that measures all your body fat and stuff...They said that its experimental and not proven and dont cover it...It was almost 100 dollars for that step on the scale, but all I had to do was call the nurse and let her know and they took that amount off my bill..

[angie92 0]

I also have UHC thru my hubby who works for BNSF Railway. I called them and asked questions also. As always am never impressed when I talk to their representatives. The guy said it was covered we just had to talk to a Care coordinator. My bmi is 46 so I hope they don't give me too much grief.

[lokiluvr 0]

I all so have UHC,,,and just like all of you every time I call them it's a cold shoulder,,,I really feel like telling them that if the do not want to be in the customer service dept. they should quit and get the *ell out!!

[anewvue 0]

I have UHC Choice Plus PPO -My husband is insured thru Union Pacific Railroad - Texas. Because it is an out pt surgery, if you meet the criteria of BMI, co-morbidies & etc.. they will pay at 100% if it is in an approved facility. (in ppo).

Please keep the faith and continue on you journey to a smaller you...

[thefunnyfatgirl 0]

I am SO GLAD to read all these great things about UHC, come January I will be covered under my father's insurance which is UHC. I have been so nervous abuot whether they cover it or not, and now after reading, I feel much better about it. Keep us informed! Thanks guys!

[Carlene 12]

So, there ARE vast differences in UHC policies. I suppose it all depends upon your group and what your employer is willing to cover.

This is the key to all those "will my health insurance cover the Lap Band" questions. Every company offers a wide variety of policies. Your UHC (or other brand) coverage will most likely NOT be like anyone else's unless you work for the same company.

My UHC is thru the company my husband retired from - American Airlines. They are self-insured and UHC only administers the benefits. So what's convered/not covered is determined by AA - not UHC. They did cover the band, by the way. My entire out-of-pocket was less than $1,000. They only paid about 50% on the psych evaluation (he wasn't in network) and they didn't pay on the nutritionist at all, plus we had the usual co-pay, etc.

[MissyC 0]

I have UHC HMO thru my job, HCA which is a large corporation. I encountered the same difficulty trying to deal with the people at the insurance co. they were rude and abrupt. BUT, after my first consult at the dr office, they took care of sending all the paperwork to the insurance co and to my surprise, I was approved very quickly with the first letter.

I have had no out of pocket except my deductible. My first 2 fills were covered in the "surg package".

I think the uhc reps should just have personality lessions. haha.

[angie92 0]

I talked to UHC today and they told me that the doctor is going to need to send in my BMI, co-morditities, and 5yr weightloss history. I asked if I didn't have a weightloss history then would that disqualify me? My doctor has had me on anti-depresssants for over 2 years for diff. things and told me they should help me loss weight. So now I'm starting to worry. I guess I should just wait till my seminar and see what happens. I do know of several guys that work with my husband that have had bypass so hopefully it'll be ok.