Questions for anyone who has answers

[Erika1982 0]

Hi Everyone,

I'm new here and I have alot of questions. But first let me tell you a bit about myself. 25 years old and married with no kids yet. I am graduating from culinary arts school in december.

I went to the doctor today, because I hurt my back nearly 2 weeks ago and it still isn't 100% he said that I probably sprained it and STRONGLY suggests that I look into bariatric surgery. I told him that for about 5+ years that I've been thinking about it but I'm kind of scared of the risks and not sure how I'm going to afford it. I do have insurance; United Healthcare. I called them about 8 months ago or so to find out if my policy covers any type of bariatric surgery, they told me no. So I'm kind of confused because I hear that united is the most lienient of the insurance companies and that they do cover it. There would be a lot less hesitation on my part if I was 100% sure that they cover it because I know that my husband and I can't solely afford it

My other question is if it comes down to me writting a letter to the insurance to appeal a denial, what should I write in it. I've never tried any medically assisted weight loss plans but I have tried Atkins and Jenny craig . I've also tried counting calories and following the food guid pyramid with little success.

My husband is supportive of me doing this as long as we can get over the financial hurdle. He has even told me that we can take out a loan to do it, but I don't want to do that to ourselves. We are planning on starting a family in the next year and I just want to be healthy and not worry about complications due to my weight. I have had 1 miscarriage and the doctor told me it may be a weight related issue and my mother had gestational diabetes when she was pregnant with my youngest brother and my grandfather passed away from diabetes complication so I think I have good reason to be concerned. Thanks for reading this and thanks for any info that you can give me

Erika S.

[hopelives124 0]

Hi Erika,

First, Congrats on your graduation from Culinary Arts school. Sounds wonderful. You must call United Healthcare again, get the name of the person you are speaking to and find out what is going on, because I have united and they are going to cover it. Initially when I called them, they indicated that they did not have the name of the program that I was using, when I gave them a doctors name, suddenly, they covered him. They have all levels of skill and expertiese shall I say. You don't have to write and appeal letter I believe until you are officially turned down. So get back on the phone with them and get a supervisor to help you if you are not clear. I have a friend with the same insurance I have at work,and he had the lap-band a year ago, and it was DEFINATELY covered by united. ( he also lost 150 pounds)

In term of children, I must say... a few things. I have three, and concieved every one at the weight of 200 pounds and above. Of course it is healthier to be thinner, and that will aid in helping to prevent gestational diabetes (which I never had), but overweight and even obese women do have children. My last two were born in my earlier 40's...that being said, you must do what you think is best for your health.

I have spent many years overweight and then obese ( I am now 260 pounds, 47 years old and have decided that I need assistance in doing this.) I would say that due to the overweight and obese problems, I have allowed myself to physically and mentally miss out on alot. I would hope that maybe with the tool of the lap-band that may not happen to you, one that is still so young and new in your journey.

So, the best of luck to you Erika, let me know how you are doing.

all the best.

Rosie :thumbup:in NYC

[JamieNP 20]

Even though SOME united policies cover the lap band, yours may not. It may be a clause that your employer put in the contract. For instance, Humana is my primary insurance. Some people here have had Humana cover their procedures, but because my company (a hospital!) did not put it in their contract, it will not cover my procedure.

You can always call back and check again. They may have changed their policy.

[fotogurl 0]

Hi Erika ~

Congrats on the graduation, that sounds exciting! I wanted to respond to your post because I also have UHC, and I was told the exact same thing, that they didn't cover it. But when I made my initial appt. this past January for the lap band, the lady in the insurance dept. told me they usually do cover it. So, that same day, I called UHC again, and spoke with someone different, told them the Dr. & the Practice that would be doing my surgery, they actually looked up my policy, and read me the part in it that said they do cover it. They do require some pre-op stuff first, but that is to be expected. The Dr's office gave me a list of things they wanted me to do pre-op before they would cover it, but it was things like, lots of bloodwork, an Upper GI, a Psych. Evaluation, things like that, nothing major. Just time consuming.

I agree with the last comment, you never know who you are going to talk to there. Ask specifically for them to read where it states it in your policy. I had my surgery on May 28th of this year, it's been 6 weeks now. I had my first fill today, and so far I've lost 30 lbs. I was very lucky, UHC covered it 100%, minus the nutritionists appts, which is a total of $500, plus a $100 copay for the hospital. I have to tell you that even though I was worried about complications, just surgery in general, not being able to eat, things like that, this has been the absolute best thing I have ever done in my life. Other than getting married & having my two children, lol. I have a lot more weight to lose, but I feel so good, I'm not out of breath as often or easily, and I don't miss food too bad after all.

Listen, don't give up. Call & call until you are satisfied with what they tell you. If you have any questions at all, please feel free to email me or message me. Let us know what happens! Take care & goodluck! :smile:

Tonya

[Erika1982 0]

OK. So I found out today that my insurance, United will NOT cover the surgery. I was told it was a direct exclusion. Therefore the surgeon I was referred to will not do the surgery because he won't do any surgerys for cash. So, with that said, do I appeal the insurance company? I'm fine with doing so, but I'm not sure that's what I should be doing. Thanks for any info you can give me.

Erika:mad3:

[Sue Magoo 71]

Erika:

You might want to go and see your human resources people to see if they could have the exclusion removed when they have their renewal with the carrier. It's such a minor change that it probably won't effect their premiums. It's worth asking.

Good luck.

Sue

[Erika1982 0]

My husband has gone to his h.r. dept. and asked them to check to see if they can remove exclusion and they won't budge. It took them a week and a half to decide this. I'm a little irritated, not because they said no but by how long it took them to get the answer to us. They probably should have said right at the beginning "you have a fat chance in hell that we are going to change our minds but we'll string you along anyway" So I have the appeal ready to go, it's been ready for about 3 weeks, i've just been wait for them to come back with an answer. If the appeal doesn't work I think we will try to find somewhere in the country that can do it relatively inexpensive and just go ahead with it. this is so frustrating.

Erika S.:thumbup: