UHC Choice plus-won't cover?

[antsmith101 0]

Thanks for your info and stuff Chris.... got approved =)

[ProsperNLose 0]

Hello All !

If I am interested in getting LapBand and my employer offers United Health Care,whicj plan should I choose ?

Traditional with Detuctible-20/500/80% Plan 7EK ?

Balanced Value -20/2000/80% Plan 7RS ?

Balanced -25/750/80% Plan 7OJ ?

or

Balanced -20/1000/80% Plan O3O ?

for a single member ,no dental ,no Eye needed .

-Your input would be great-

[destiny79 0]

I am not sure that's the same as what my company offer mines was

90/10 with 300.00 ded. 1400.00 max out of pocket .

I paid in total 1420.00 for surgery I had to pay Dr. 20.00 co pay :eek:hospital 1400.00.

[Chris61 0]

I would check with UHC and your employeer and see which covers the lapband and go from there. There is so many programs it is hard to tell. I have the choice PPO and it only cost us out of pocket something like 400.00 for both my wife and I.

Chris

[Kalipso2 25]

i'm afraid i may be just out of luck here... i called UHC and the customer service person said the surgery is NOT covered.

i went to my HR department asking to see my coverage benefits and sure enough... it's on the exclusion list.

would it do any good to find an insurance company that does cover it and pay for the coverage for awhile? would that even work?

[NYGMEN 0]

Well they are taking me down to the last day. I'm set to get banded on Thursday but we are still waiting for UHC to approve it. It's going to be a long 24-48hrs.. I hope to hear soon.

[NYGMEN 0]

APPREOVED!!!! Just got the phone with the Doctors office.

[stI24nger 1]

Congrats, and good luck tomorrow. Your life has officially changed--for the better!!!! Get some rest, and enjoy those pain meds!

[TulipStar 2]

i'm afraid i may be just out of luck here... i called UHC and the customer service person said the surgery is NOT covered.

i went to my HR department asking to see my coverage benefits and sure enough... it's on the exclusion list.

would it do any good to find an insurance company that does cover it and pay for the coverage for awhile? would that even work?

I would ask your HR rep if there an appeals process to try to get approved?

[Chris61 0]

I doubt that you will have much luck with appeal if it is on not on the list. A few years ago I had the same problem and then I happen to go back and relook at the plan and say that it was changed. I would talk to HR and also send a letter to your company president asking to make changes to there plan. Might even try and get a wrtting campain to get the companyto change.

Chris

[boredryu 0]

I've posted a lot of single threads but I know see this thread is perfect for me.

I have my initial visit on tuesday with AIG/Lap band Solutions. I have a 100 dollar yearly deductible (haven't been met) and a 10%/90% coinsurance.

I called to see if AIG/lbs was in-network for uhc in dallas and the lady said "yes, but even if the doctor was out of network they charge in-network rates"

Does that mean my surgeon could be out of network? The problem with that is it goes to a totally different scale (I think 40/60 coinsurance) with a much bigger yearly deductible.

Luckily for me I have WLS included in my benefits and I won't let a little thing like a 5 year documented weight history stop me. I have a checkup listed for pre-diabetes symptoms back from 2004 and I couple things in between so I hope that will suffice.

Anyway, Chris or anyone else still reading these things your advice with AIG/lbs or in general would be appreciated!

Edited April 11, 2008 by boredryu

[TulipStar 2]

Appeals work even if its not on the list. I have appealed something twice and was approved (one was considered cosmetic).

Boredryu -- For my UHC plan all doctors at LBS are covered. However, your plan may be different. You might want to use UHC online too to check if their dr's are covered?

You'll need documented weight 5 years back, so that includes 2003 too. LBS does everything for you, which makes it easy. Waiting is the worst part!

[JudyAnticola 2]

Just got off the phone with UHC....the guy on the end of the phone sounded like he had no clue. He said that it was not covered. I gave him the CPT code, he said it was not covered. So many of you have UHC...I was really suprised. He said to call my HR manager...but it is my DH job, and I don't want to talk to anyone up there if I can avoid it. Any suggestions? Should I just keep calling, or is NO a NO?:thumbup:

Also Choice Plus UHI, employer did not opt for the plan that covers the LapBand. HR is looking into it, but I do not think there is anything that can be done unless the company your work for changes plans. I hope something works out for you.

[boredryu 0]

Something amazing happened today while I was in the cafeteria at work. Someone from another dept who i've met through meetings and conferences saw me in line and we talked. She was getting buffalo wings and said "I shouldn't be eating this I've been banded".

I asked her when she got banded and she said in feb 08. She also told me about a lot of other people who've been banded too. I asked her who she went to see and she said they all went to Dr. Richard Carter and how simple it was to get approved. Not one of them had to document a 5 year weight history, they just went in, had a really high bmi or a middle bmi and symptoms and were immediately approved.

They all recommended him so I canceled my appointment with LBS and filled out an app with carterlapband.com. Anyway, I'm really excited!

[destiny79 0]

LBS also use Dr Carter has a Dr. my soworker had it done with him, now he don't do fill til 3 month post and she hated that, I had already lost 40lbs about time she got her first fill so do some research.