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!!!!

[allykat 1]

But what I basically said there was that I also work for the State and have UHC and was told it was approved. Trying calling with the procedure codes and see what you find out. Good luck. You've made me nervous now that maybe I was given wrong information!

[heavenlyceleste 0]

Read my post at: http://www.lapbandtalk.com/f31/we-self-pay-state-no-help-law-50016/

My research led me to learn that the laws in GA do not protect the patients.

Good luck!

[mbanja 1]

My hubby is a police officer and when he needs to find out about laws he goes to a website called findlaw.com , you could try finding the law there. Also, can you see if any of the other ins that is available for you covers it. Maybe you could switch. I worked with the police dept as a civilian and there was a lady who needed the surgery badly but her current ins didn't cover it. She appealed to the HR dept and they let her switch providers so she could get it. They let her switch before the annual "choose you ins" thing that is required. I would suggest talking with your HR dept, or if you work for the dept, start looking up the stuff in all the ins proceedures.

[heavenlyceleste 0]

I have researched it extensively. GA is just not a good state for this surgery. People who work for big companies definately have better options. We looked into getting new insurance for my husband's whole company but there was nothing for the less than 10 people company that would cover it. I do not mean to be depressing but I wasted 6 months waiting for this info to be clarified for me. It took one more diet after learning this for me to decide to go ahead and take out two loans to pay for it ourselves. I am so glad that I did and only wish that I had done it 6 months sooner.

-Celeste

Goddess Talk

[char1954 0]

I live in SC. My husband works for the state; we have Blue-Cross Blue-Shield. They would not cover my surgery. Several years ago, a friend had bariatric surgery. She said she had to have it before the end of the year because after that it would not be covered. I ended up having my lapband surgery in Monterrey, Mexico; Dr. Miguel Zapata performed the surgery, and I was very pleased. I was in and out and awakened 45 minutes later. The hospital was beautiful and spotless, and the day after my surgery, I was sent to a four star hotel for two days for my recovery. My meals -- broth and Jello -- were included. The patient co-ordinator visited often. I had my own driver who knew the routine and took excellent care to see where I needed to be and when. The whole thing, including my air fair was about $8,000, as opposed to having the procedure done in Jacksonville, FL, for $30,000.

I had my surgery on July 13th and have lost 50 pounds. I've only had one fill. I have about 35 more pounds to lose. I would probably have lost more had I exercised regularly. :frown: The scars are minimal. The company who made all the arrangements is called Ready-4-Change. I highly recommend them.

My only complaint is that the closest fill center is 5-6 hours away.

I know $8,000 is a lot of money, but I have never done anything just for me. It was a gift to myself. I would do it again in a heartbeat!

Hope this helps.

C. Hughes

[heavenlyceleste 0]

I looked into surgery in Mexico and decided that i was not comfortable with it. My charge, including a year of follow up was $18,200. Just an FYI for those researching.

[GreenChrysalis 1]

There are definitely less expensive options in the U.S. I was originally going to go to Mexico but was never very comfortable with the idea for various reasons. Then further research turned up reputable, experienced surgeons in the US that charge an affordable amount for self-pay patients (of course affordable is subjective, but for me, it was under $10k). I chose to go that route.

I would never say that it's inherently "better" to get surgery in the US or that there's anything "wrong" with getting surgery in Mexico. It's a very personal choice and you're ultimately the only person that you have to please with that decision. Just thought you should know that there are many options out there.

[MickATL 3]

Follow-up with Emory. Their Bariatric office staff is excellent! Also, sometimes you have to call and speak to different people to find out. The best bet would be to let Emory submit the procedure codes you want. I have BCBS of Georgia and they covered my lap band. Some insurance policies cover out-patient surgery but not in-patient. So same day laproscopic out with-in 24 hours was covered by mine but not extended stay more extensive surgery.

You may want to write down who you speak with, ask them to email or fax you a copy of your policy where that is spelled out or indicated. If you don't like their answer. I would hang up and call back and speak with someone else until they can show you in writing where WLS is excluded.

Don't give up. Be diligent. It's alot easier for people to give you a quick answer than to look things up and verify. So if you can't find the exclusion on the website, make them show you where it says it. If they can't, it's covered. Again, I would let Emory go through the approval process for you. Don't give up. Don't lose hope.