My Insurance doesnt cover WLS but......

[santos91 1]

So right now im waiting to go to a seminar.

Well before anything i called my insurance united healthcare to make sure they cover WLS. Well the lady says my plan does not cover any kind of weightloss program including WLS. She did tell me if i pay my deductible they will cover 80% and id have to pay the 20%. Also i did ask the lady if there was any requirements(6month diet plan) i had to do to be able to get approved & she told me no. All i have to do is pay my deductible and 20%. I really hope she is right. Insurance is so hard to understand sometimes. I just dont understand how my insurance doesnt cover WLS but if i pay my deductible they will cover 80%. How is that?

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[VSG AJH 499]

If it's an exclusion, they won't cover it. However, if your surgeon bills using a non-WLS code and/or if you get through the appeals process based on medical necessity, they may cover. You will want to get any coverage in writing in advance of your surgery, or you could be stuck with the bill.

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[santos91 1]

The insurance lady did say something about benefits but i couldnt quite understand her because my phone was breaking up. I think maybe she said " let me see the benefits of WLS" im not sure though , i could be wrong.

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[J.lynn 50]

If they don't cover WLS, then they don't cover WLS. I am not sure why your insurance agent started explaining your benefits if your question was whether or not WLS was covered.

For ex, my insurance covers WLS after I have met my deductible of $2600, then they will cover 80% of the surgery until I meet my max out of pocket.

If it is a group based plan, try reaching out to your HR manager and make a case for getting it added. A lot of employers choose to not elect for WLS to save on premiums without taking into consideration obesity related illnesses.

Also, you could research going to Mexico. There are many reputable surgeons that are just as good if not better than surgeons in the US.

Edited March 29, 2016 by J.lynn

[santos91 1]

Thank you @@J.lynn

The way u explained it makes better sense. I guess they didnt explain it correctly or something.

Pretty much all she said was "no your policy doesnt cover WLS or any kind of weight loss program but if you pay your deductible($2000) then we will cover 80% and then i would pay the other 20%. I was just like ok thanks and hung up....i guess i will have to see what happens after the seminar.

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[santos91 1]

I get insurance through my husband's work company.

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[kmorri 1,689]

Yes the others are right.....if WLS is not covered by your plan then they will not pay anything.... there would be no way you could meet your deductible if the surgery is not covered.....non-covered services do not apply to the deductible....I work in the insurance business. Please make sure to get clarification from them....and ask for it in writing. The doctor's office can also check your benefits for you. Good luck.

[santos91 1]

Thank you kmorri. I will let the doctors office know what the insurance people said. I didnt think it made sense either, what the lady was saying. I hate dealing with insurance. Ugh thank you everybody.

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[cat saaski 104]

I would call back and talk to someone else. If you still get mixed messages ask for a supervisor. This is an big expense, you don't want any sunrises post op.

[santos91 1]

What exactly should i say when i call back? Maybe its me asking my question wrong idk. I just ask them if my policy covers weight loss surgery.

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[ising4godinohio 8]

Also, if your employer's plan is self funded, you might want to try to talk the employer into intervening on your behalf. The employer can request the surgery be approved if you meet medical necessity

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[ising4godinohio 8]

If you call your insurer, you want to ask if wls is a stated exclusion . If so, you want to ask if their medical guidelines offer any criteria that can override the exclusion. Also, if your employer's plan is self funded you can ask your employer to request an exception on your behalf

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[mmorris4 14]

I also have United and it is NOT included in my insurance plan. The whole you pay 20% is wrong. I can guarantee if you call back and ask about it they will tell you that they don't cover ANYTHING. I am self pay because of this as well. I am also on my husbands insurance plan. Good luck. I personally think it should be covered on all plans.

[courtney2016 5]

I have UnitedHealth through my husband's employer. My deductible is $250, they will cover 90%, and my max out of pocket for the year is $2000. So the most I would have to pay is $2250. My deductible has already been met. I just have to do the 6 month supervised diet. In month 2 and already down 20lbs.

I told my hubby he could never leave his job. They have awesome insurance. His open heart surgery cost us $1500 which included 2 hospital stays and a home nurse. I had fertility treatment and got pregnant through fertility meds and insemination. Only cost $350, and that includes the co-pay to have my baby.

It really depends on the group policy.

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[CrissyCakes 110]

So right now im waiting to go to a seminar.

Well before anything i called my insurance united healthcare to make sure they cover WLS. Well the lady says my plan does not cover any kind of weightloss program including WLS. She did tell me if i pay my deductible they will cover 80% and id have to pay the 20%. Also i did ask the lady if there was any requirements(6month diet plan) i had to do to be able to get approved & she told me no. All i have to do is pay my deductible and 20%. I really hope she is right. Insurance is so hard to understand sometimes. I just dont understand how my insurance doesnt cover WLS but if i pay my deductible they will cover 80%. How is that?

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So most insurance will list these surgeries as not covered. However, if something is medically necessary and your Dr's can provide proof of that then you can submit for an authorization to get it done. Your surgeon would submit your medical history and outline why you need this. There's usually a standalone department that consists of nurses and Dr's that will then verify if you do qualify for the surgery. If denied you can appeal, twice I believe with most. I work insurance and I've seen things not covered, paid out by the insurance. Best of luck with it all.

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