Re: insurance changes re gastric bypass surgery

[Guest guest]

The BC/BS info came from a department head at BC/BS here in NE FL. The

info on PS was from a plastic surgeon's office manager who has been

receiving insurance updates with the no PS and no payment for

complications. Good idea about checking with ASBS - I dropped into their

office last week to visit and never once considered asking them. Will be

in their area again next week and see what they have to say.

Amber FLRN

insurance changes re gastric bypass surgery

it would be interesting to see a few insurance companies try omitting

what

has become a standardied life-saving surgery, and get sued really hard.

I would

suggest you ask the legal eagles at ASBS; they ought to be up sharp

about what

is coming and what it not.

To the soul who said United Health Care was dropping their WLS

provision, we

had United Health Care 4 years ago when I had surgery and they turned us

down

flat, after " losing papers " 6 times, you know the routine. There are

numberous

UHC plans, the employer often scrimps on insurance, for their costs are

cheaper if wls and other surgeries are omitted, or are high co-pay.

love,

ceep

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[Guest guest]

> To the soul who said United Health Care was dropping their WLS provision,

we had United Health Care 4 years ago when I had surgery and they turned us

down flat, after " losing papers " 6 times, you know the routine. There are

numberous UHC plans, the employer often scrimps on insurance, for their

costs are

cheaper if wls and other surgeries are omitted, or are high co-pay.

*** and yet UHC is the only insurance co. in the entire SC area that will

approve the lap. gastric band. no one else will touch it even though its

been fda approved for 4yr.

sue

[Guest guest]

-> There are numberous

> UHC plans, the employer often scrimps on insurance, for their costs are

> cheaper if wls and other surgeries are omitted, or are high co-pay.

>

> love,

> ceep

I experienced this and had the worst time with it. The employer I had worked

at for 7 years had lousy insurance. Not due to the insurance company itself

but because of my employer being self-funded. They dictate what is paid for

or not, not the insurance.The insurance itself is merely the administrator of

the

health plan, they have no real say in what is or is not covered.

I was denied three times even though I met all of the criteria according to the

NIH guidelines. In fact, I had gotten to the point where I hired a lawyer and

was going to force them to pay when they up and switched to an insurance

with an ironclad exclusion. So, I left, got another job that had insurance I

knew

would pay, (from meeting a postop patient who worked there.) I was approved

within 2 days. It was worth losing $3 an hour in pay.

Fast forward 2 years, I am back at my old employer, (I can't find a better

paying job in this area.) I get my new insurance booklet, check the exclusions

and guess what? Gastric Bypass or any weight loss surgery is specifically

excluded. All because of lil ol me? You bet.

Whether gastric bypass is covered usually has to do with 1) the employer and

what they are willing to pay for in their benefits package, 2) the insurance and

whether or not they conspicously offer a package to employers with iron clad

exclusions built in. Let's face it, most companies don't want to pay for wls,

but

then again, some do. I am glad I got on with a company that did.

M