Once in a lifetime benefit

[mswyatt1967 1]

Hi, I have a question and wanta know if anyone has been through this before, I had gastric band done 4 years ago and was under my boyfriends policy Cigna, which you can only have weight loss once in a lifetime, so I had to have the band removed, now my boyfriend company has UHC but he's still with the same company anyone know if that once a lifetime max would apply to a totally difference ins company but under the same employer, I'm trying to get the gastric bypass?

[jj7481 363]

Different insurance company, lots of changes since implementation of health care law, and several plans with each insurance provider. Unfortunately, there are too many unknowns since different employers can have the same insurance company but different policies/coverage.

Contact UHC with your current policy number and get a definitive answer.

[psychprof 141]

Call them.

[cadladykim 55]

Call them! Do NOT rely on the doctor office to find out for you! I have a horrible situation I am going through now because I just let the doctors tell me it was covered, only to find out later that yes it is covered, but only to a certain dollar amount - the rest is out of pocket! I could have negotiated some rates and possibly had some other help had I known and called on my own.

[Sajijoma 1,324]

Usually once in a lifetimes only apply to the policy you were holding at the time you had the service. So for instance, the once in a lifetime coverage for wls when you got the lap band would only apply to as long as you had Cigna since that was the insurance you had with the stipulation. If however, you have an insurance plan through an employer and the employer contracts out who will oversee the insurance like mine, the once in a lifetime could still apply if the employer switches from say Cigna to Aetna to cover their employees if they are the ones who made the insurance plan themselves. Really, the only way you are going to know for sure is to call your currently insurance and ask them what they cover and if they have any stipulation on things like that. Most of the time they won't, but you need to know before you sign up for an expensive surgery. I nearly fainted when my bills showed up from my rny because I wasn't expecting them, but the hospital had my insurance # wrong in the system so they sent me the bills instead and I had to get it straightened out. There's a big difference between paying nearly $2000 and paying nearly $800,000 so it's super important to know where you stand.

[mswyatt1967 1]

Thanks everyone I called the current policy now which is UHC and the agents in customers service says the lifetime limit applies to this UHC plan, and I ask her even though it's under the same employer group just switch from Cigna to UHC she still said the limit only applies to UHC I just hope it doesn't come up later when trying to get auth are something, my doctor even called them and they told them the same thing that limit applies to UHC so I hope all is good.

[jj7481 363]

Thanks everyone I called the current policy now which is UHC and the agents in customers service says the lifetime limit applies to this UHC plan, and I ask her even though it's under the same employer group just switch from Cigna to UHC she still said the limit only applies to UHC I just hope it doesn't come up later when trying to get auth are something, my doctor even called them and they told them the same thing that limit applies to UHC so I hope all is good.

Best thing you can do is start the process early. Most bariatric centers are quite familiar with dealing in pre-auths and getting the specifics of your insurance policy (they want to know they're getting paid also).