Disappointed in Atlanta

[kirby1968 0]

A friend and I attended a weight loss metting at Emory University last week. I enjoyed the meeting and it was so GREAT to talk with other people at the forum as it made me realize how much in common many of us have.

I was so pepped up after the meeting because one of the speakers mentioned United Health Care (UHC) and how great they were about providing coverage for Bariatric surgery.

I work for the State of Georgia and I have the State Health Plan which consists of different plans you can choose from. I was so glad that I had chosen UHC.

To my disappointment, I contacted UHC the next day thinking I was on my way and being one step closer to having the surgery when I was told that my plan does not cover weight loss surgery. I had researched the website prior to contacting UHC but under my plan benefits it said nothing about whether or not the plan covers the surgery.

I'm not sure where the person that I spoke with found the information but it was not listed anywhere that I could see. My best friend has Aetna and he found out that his plan offered bariatric benefits. So needless to say, I am kind of down that we will not be able to go through this together.

My friend stated something to the effect that Aetna told him that there had been some new law that the state of Georgia passed in recent years regarding bariatric surgery and insurance paying for it. It was a good law but I haven't been able to find anything regarding this law.

First, is there anyone who works for the State of Georgia, particularly Department of Human Resources (DHR) who has had bariatric surgery and UHC paid for it????? Secondly, does anyone know about this law that was supposed to have been passed?????

I would appreciate any suggestions/advice you could provide. Thanks!!!!

[WASaBubbleButt 41]

Did you try posting this in the state of Georgia forum? I'd try cross posting it there as well.

[kirby1968 0]

Thanks for the info. I am new to forums and have never posted in one. I posted it in Georgia. Thanks for letting me know that there was a state of Georgia thread.

[allykat 1]

Now you've made me nervous! I also work for the State of Georgia and have UHC. I called and asked specifically about the lap bad and used the procedure codes I found on this board and I was told yes, it was covered 90% inpatient or outpatient. Not sure why you were told that? I repeated the code back twice and even told them the name of the procedure and they said it was subject to individual review of the physicians predetermination form or something like that. Try calling again with those procedure codes!

[kirby1968 0]

Hi Sheryl, do you have the name of the person you spoke with? The person I spoke with did not seem to convince me that they knew what they were talking about. That is why I wanted to submit my post.

[kirby1968 0]

Hi again Sheryl,

You mentioned in your response, "I called and asked specifically about the lap bad and used the procedure codes I found on this board and I was told yes, it was covered 90% inpatient or outpatient."

Since I am a newbie to forums in general, could you educate me on how you found the information stated above on this Forum. I would be most appreciative. Sorry I scared you.

Kirby

[allykat 1]

I don't know who I talked to, I just called the 800 number on the back of the card and told them I was considering a procedure and wanted to know if it was covered. I found the code on the "Insurance" subforum here, under one of the stickies. Here it is cut and pasted:

43770 – Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band (gastric band and subcutaneous port components).

I gave them that code and then said the lap band procedure and they said it was covered! Let me know what happens when you call back. I'll call again tomorrow as well.

[allykat 1]

Kirby, I'm going to join you in being disappointed! I called UHC this morning and used the CPT code and also gave the name of the procedure and asked about exclusions. You were told correctly, weight loss surgery is excluded. However, she did say that if it was approved by our company, they cover it. She suggested submitted an appeal complete with medical documentation and just see where it goes.

I was soooo ready for this and now I'm soooo disappointed!

[GreenChrysalis 1]

This happened to me too -- my husband works for the state and has the UHC State Benefit plan. I called and asked by procedural code if the lapband was covered. They said yes. I looked online and saw some people saying that it was not covered. So I called again and was told no by a different person. I requested a written copy of my policy that contained exclusions so I could see it for myself; obviously just calling and speaking to someone at UHC is not enough. So I got the policy and there it was in black and white. No bariatric surgery is covered.

I decided to self-pay. I will submit my bill as a claim and see what happens but I am not hopeful that I will get reimbursed for anything. I don't expect Georgia to change its policy anytime soon. I haven't seen anything about a law but will look for that.

It's very frustrating that the reps at UHC are giving out incorrect information. Perhaps they are not looking at the State Benefit policy; I'm sure that other policies cover it but ours does not. It is very upsetting to hear one thing from one rep and a different thing from another. :pray2:

[allykat 1]

I am just so disappointed about this. I don't think selfpay is an option right now because I don't have that much built up and I really don't need another payment. I just don't know what to do.

[WASaBubbleButt 41]

I am just so disappointed about this. I don't think selfpay is an option right now because I don't have that much built up and I really don't need another payment. I just don't know what to do.

I think people seriously underestimate the cost savings in losing weight. Grocery bills alone can be cut drastically.

Do you realize my band will pay for itself in 1.5 years JUST in fast food savings and diet soda? Of course, I was a hard core fast food addict.

I probably spend $20 a week in actual food for myself now.

My suggestion is to get your grocery bills, restaurant bills, fast food bills out and keep track of them for a month. See just what you are spending in maintaining your weight each month. I think you might be shocked at how expensive it is to be overweight. I spend $20 a week in grocery bills, an absolute max of $30 a week, rarely eat out, VERY rarely eat fast food. No diet soda ever. I easily spent $100 a week staying fat.

Just something to consider.

[GreenChrysalis 1]

WaSa has an excellent point. I thought about that myself when looking for ways to self-pay -- I spent a lot of money on food and on diet soda. Once I looked at it that way, I realized that I would not only save money there but I could also cut back in other small ways to afford it. And if you are on medication for co-morbidities like diabetes or HBP (thankfully I am not) you may be able to reduce or eventually go off of them completely -- so think of that.

I used a credit card because that was the best option for my situation. But there are many ways to find the money -- many surgeons work with loan and medical financing companies, and many of them have a lower rate for patients who self-pay. So don't give up yet. I don't like the extra bill but I know that I am worth it. :tt1:

[lafevretj 0]

I also had UHC (I work for the State of Ohio), I was told they had an "exclusion clause" for bariatric surgery. In June I changed to Ohio Med, which will cover. I have recently completed my 6mos physician supervised weight loss program and everything should be submitted to my insurance company in the next week or so. Have you thought about changing to an insurance that will cover?

[make33 2]

Yes, everyone is so-o-o right about the cost of groceries--you would just be amazed at how little food you would be able to eat!

I was also taking Nexium that was costing me $50 a month plus 5 Zantac a day (At $20 for 80, that's another $40 a month I was spending!).

So if you can, I would seriously consider being a self-pay (even though if you can get on insurance that covers, might be cheaper and easier!) :tt1:

[Lynn43 0]

The company that I work for has UHC. Last year I tried to get approved for the the lapband surgery. At the time I had the EPO. I was told by a representative at UHC that the surgery was covered. They paid for all of my testing. I attended all of the required classes. When my paperwork was submitted I was denied. When I questioned what I had been told I was told that UHC had misinformed me. The surgery is covered under the PPO and not the EPO.

I changed to the PPO at the beginning of the year. My paperwork has been resubmitted. I'm hoping that it will approved.

Each company decides what they want to cover...thankfully my employer decided to let this be an option with the PPO.

Try to exhaust all of your options...I know how disappointed I was.

Good Luck!