Well no surgery for me

Was just informed today my United health care plan has a 6 month weight loss plan so I guess I wasted a lot of money for nothing! I have no choice now but to try this on my own!   Wish me luck and if I do get down to onederland I will let you know. So sad today was not expecting to hear this since this was the first question I asked weight loss clinic and insurance co. Why can't this info be made know ahead of time so people can plan financially for it!  I am sick of corporate America and insurance companies. The consumer never wins!

Not sure I understand. Some of their plans require that you go on a 6 month plan before they will approve surgery. Others simply have an exclusion. My wife actually works for them, and our policy had an exclusion. This meant that there was no possibility of them paying for it. We had to self pay, and enlisted family who helped us with it.

The 6 months isn't a weight loss trial?  I had to do a 3 month weight loss trial for my insurance, and after that I was approved within days.  If it's a matter of documenting your weight for 6 months and seeing a nutritionist or something, it's SO worth it.  It takes extra time, but if the goal is surgery and that is what they are asking for, go for it!  If I'm misunderstanding your post, I'm sorry.  Best of luck either way!

Ok, help me out here.  You can still have the surgery as long as you complete a 6 month weight loss plan?  If that is the case and will be able to have the surgery, why not go ahead and do it even though surgery won't be when you wanted it?  I wouldn't give up that easy unless I am missing something here. Did you read over your United health care plan yourself before you proceeded with any of the pre-testing?  that was YOUR responsibility  and let this be an important lesson to everyone out there that you must be your own patient advocate.  Do not leave ANYTHING that you have control over to other people, surgeon's nurses, Insurance companies, no one.  Somewhere along the line there is information missing.  Had you seen the surgeon at all prior to starting anything and if you did, did you not go over all requirements for pre-approval?  I am very interested to see where the ball got dropped on this one.  Don't give up unless you choose to.  Best of luck, Jane 

I also have to do a 6 months weight management prior to approval for surgery and like yourself i am not able to afford the coast. So i did a bit of digging around and i found a loop hole i could lean on. I found out that the weight management had to be supervised by a medical professional, so in came the question what if i do it with my PCP. The answer was yes. So the cost of a DR's visit is way cheaper then going to a BMI clinic.  Give it a try and don't give up it seems like a long time but its good time to practice your soon to be new habits that's the way i look at it. on the 29th will be my 2nd appointment . Best regards 

Bibi

I was sent a packet of information from my insurance as soon as I made the initial inquiry.  I don't understand the whole corporate America thing.  Insurance companies will tell you what is covered.  You have to ask.

Do you mean they require you to do a six month supervised diet before they will approve surgery?  Or they do not cover surgery at all and want you to do a diet instead?

It's common for insurance companies to require the supervised diet - although it's stupid because there is evidence that it does nothing to improve outcomes for patients that go on to have surgery. 

It should have been made known ahead of time.  Your insurance policy didn't specify the criteria for WLS or whether or not it was covered?  You should have been able to see that information at the time you purchased your insurance policy.

Looking over your past postings I see that your problem is having to pay a $3000 co-pay if you don't have your surgery done by July 1st, correct? If you have a 6 month waiting time for a supervised diet, use that time to save, save, save and borrow money. You may also be able to finance the co-payment. It seem like you won't be able to, but you can work it out!!

Martha 

1. I did ask and ask and asked again.  The clinic was informed incorrectly. They said the insurance co told them it was a 3 month it was not until they submitted it may 9th that United healthcare informed them my company policy requires 6 months. I was told the 1st of march that the clinic verified the waiting period. We even called the insurance co when I was at the clinic.  Because of my high deductible and out of pocket expense I just cannot come up with the money to get this done my next plan year.  Yes had I been advised the waiting period I would have not started the process until my new plan year or at least not jumped thru the hoops and spent the out of pocket expense.  I feel like this information is crucial to the patient and insured to make decision properly for them. The was  such a shocker cuz I have done my research. Even my company can't find anything about the waiting period exclusion to prove it to me. I did call numerous times and searched my plan on line almost daily to make sure I was not missing anything!  

• Clinic claims they were misinformed.  The insurance policy just states it is covered with pre notification which I did and so did the clinic.   My company benefits dept can't find the requirements either