Insurance exclusions

[trm 14]

I have United Healthcare Choice Plus insurance in PA through my employer. There is an exclusion for surgery for obesity. I wanted to get the gastric sleeve. I have hiatal hernia, reflux, sleep apnea, fibroids (requiring a hysterectomy), pre-diabetic, and early stages of hypertension.

Is there any work around for insurance?

Thank you!

[samantha614 12]

Doesn't sound like it :/ are you able to switch to a different insurance that offers it? You can always call the insurance and ask if it's a definite exclusion or if they will consider it if your PCP recommends it.

[trm 14]

Only if it isn't recommended for obesity.

[atlmag 77]

There are surgeons that will do the Hernia repair under your insurance coverage and offer to the sleeve at the same time as the Hernia repair at a reduced rate. While there is still a cost to you it is cheaper than the self pay price.

[trm 14]

@@atlmag I will have to see if the recommended surgeon does.

[tdc 56]

@@trm see if the doctor can write it up as prep hernia removal and prep for hysterectomy

[Nora82 11]

Talk to your HR. In most cases your employer can give you an administrative override to cover the surgery specifically for you. You will most likely have to present all the benefits to the company for you having this surgery (increased productivity, lower health care costs after surgery, etc.). I am an insurance coordinator and am currently working with one of our patients HRs. They've never had a request for an override but they are seriously considering it.

[trm 14]

@@Nora82 I will ask them tomorrow. Thank you.

[LadyWarren 57]

Open enrollment for Health insurance is going on right now. So, you may want to check out other insurance companies. If you enroll by Dec 15, 2015, your coverage will begin on Jan 1, 2016. The deadline to enroll is Jan 31, 2016. Good luck!

[ladycook9713 442]

The True Results company also has an option for surgery if you have a hiatal hernia. They will bill to insurance as a hiatal hernia operation and do the sleeve/bypass while they are in there. It's something worth checking out. I didn't have a hernia otherwise I would have gone this route since it would have been cheaper.