Re: United Health Care with exclusion

[Guest guest]

I assume you mean your particular plan excludes GBS, because we have

United Healthcare and they covered my GBS.

We had some over-run costs, but they were small in comparison to what

they did pay.

[Guest guest]

I have UHC as well and am waiting on approval. Do you remember how

long it took for them to approve your surgery from when you

submitted all your info?

Just call me anxious.

Caryn

> United Healthcare and they covered my GBS.

> We had some over-run costs, but they were small in comparison to

what

> they did pay.

[Guest guest]

Caryn,

I'm sorry I can't give you an exact time, but it was sooner than I'd

expected. I'd guess at 2 to 3 weeks.

First UHC gave their approval, then my doctor scheduled me for all the

exhaustive testing, so then we had to re-submit. The approval is only

good for like 30 days.

But both times I was surprised at how quickly it went through.

> I have UHC as well and am waiting on approval. Do you remember how

> long it took for them to approve your surgery from when you

> submitted all your info?

>

> Just call me anxious.

>

> Caryn

[Guest guest]

> I am preop and am fighting the insurance demon. My company is

self

> insured and use United Health Care. They have an iron clad

exclusion

> that will not permit weight loss surgery at all, bottom line.

I have United Health Care and it is covering the costs, but do not

know what percentage yet. My husband pays the biils, I get to stay

ignorant. We are sopported by one income so if we were overburdened

by bills, I would hear about it. So far, so good. Janet

[Guest guest]

Janet I am sorry you're having so many problems getting your surgery

covered. I was denied by my ins. provider the first time and had to

appeal and it was so stressful waiting and wondering and having to

basically beg for the surgery. This surgery really was my last

hope! I had my dr help me with the appeal letter and I would really

recommend you check out the obesityhelp.com website and post

something there too. There is some good files on that site about

dealing with ins. companies and if you post something you might

connect with someone else that has dealt with the same companies you

and your husband have.

Good luck and keep us posted!

This surgery has been a life saver for me!

Bridget

> > I am preop and am fighting the insurance demon. My company is

> self

> > insured and use United Health Care. They have an iron clad

> exclusion

> > that will not permit weight loss surgery at all, bottom line.

>

> I have United Health Care and it is covering the costs, but do not

> know what percentage yet. My husband pays the biils, I get to stay

> ignorant. We are sopported by one income so if we were overburdened

> by bills, I would hear about it. So far, so good. Janet

[Guest guest]

Thanks! - an approximate was all I was looking for. I know they

received all my info last week, so I am going to be calling every

few days to get a status update. This is per the hospital

coordinator's advice.

Caryn

> Caryn,

>

> I'm sorry I can't give you an exact time, but it was sooner than

I'd

> expected. I'd guess at 2 to 3 weeks.

>

> First UHC gave their approval, then my doctor scheduled me for all

the

> exhaustive testing, so then we had to re-submit. The approval is

only

> good for like 30 days.

>

> But both times I was surprised at how quickly it went through.

[Guest guest]

I have united health care and they are paying 90% of my surgery. It

is a covered expense.

> I am preop and am fighting the insurance demon. My company is self

> insured and use United Health Care. They have an iron clad

exclusion

> that will not permit weight loss surgery at all, bottom line.

Well,

> one of the gals that I work with had the lap band. Her husband's

> surgery was going to cover the surgery after UHC denied the

> coverage. She had her surgery in February. As the bills started

> coming in, UHC started paying for them. They paid the pre-surgery

> testing. She told me that and we just figured that it slipped by.

> Then she told me that they paid the total hospital bill, the doctor

> bill and even several of her fills!! She has called them, told

them

> that they covered a procedure that is an exclusion in our policy.

> The customer service person acknowleded the exclusion, but said

that

> it was sent through. Has this happened to any of you?? I am so

> confused. She does not want to say anything because she is not out

> any money because her husband's insurance will pick up anything UHC

> will not pay. In the past 2 years, I have approached my HR

> department to get out policy changed. Does anyone know how long my

> coworker would have to wait before UHC could not come back and

> reverse the payments that they have already paid?

> Sorry this was so long. Thanks for any information you can offer.

[Guest guest]

I have United Healthcare too, through my husband's company. My policy

said that absolutely no treatment of obesity was covered, including all

of the surgeries, counselling, etc. However, we got the referral from

the doctor, the OK from the surgeon and the psych exam and voila....I

was approved. I had to have the surgery in an " in network " hospital or

nothing was covered, but that was not a big problem....I just went to

the in network hospital. So far I haven't even gotten a bill for the

co-pay, which I am expecting, and I am a little over a month out. I

don't know if it was what the surgeon said, my BMI (50), the referral

from the PCP or what, but whatever it was, it went through in spite of

what the policy said.

I hope the same thing happens with you!

Cindy

tlwweaver wrote:

>I am preop and am fighting the insurance demon. My company is self

>insured and use United Health Care. They have an iron clad exclusion

>that will not permit weight loss surgery at all, bottom line. Well,

>one of the gals that I work with had the lap band. Her husband's

>surgery was going to cover the surgery after UHC denied the

>coverage. She had her surgery in February. As the bills started

>coming in, UHC started paying for them. They paid the pre-surgery

>testing. She told me that and we just figured that it slipped by.

>Then she told me that they paid the total hospital bill, the doctor

>bill and even several of her fills!! She has called them, told them

>that they covered a procedure that is an exclusion in our policy.

>The customer service person acknowleded the exclusion, but said that

>it was sent through. Has this happened to any of you?? I am so

>confused. She does not want to say anything because she is not out

>any money because her husband's insurance will pick up anything UHC

>will not pay. In the past 2 years, I have approached my HR

>department to get out policy changed. Does anyone know how long my

>coworker would have to wait before UHC could not come back and

>reverse the payments that they have already paid?

>Sorry this was so long. Thanks for any information you can offer.

>

>

>

>

>

>

[Guest guest]

I used to work for a large healthcare administrator and our main

client was UHC. We administered several of their plans. They had

the GBS exclusion, UNLESS IT WAS MEDICALLY NECESSARY. Of course

this last part was worded elsewhere - it said medically necessary

surgery in general was covered. We paid for a lot of these

surgeries. I hope this is one of the plans you have. Either way,

keep fighting them!

11/18/03

284/249 preop/163