Question:
I have recently read that United Healthcare will stop covering WLS as of 3-15-02.
Has anyone else heard that?? I have UHC Choice + policy. — MaryBeth R. (posted on March 4, 2002)
March 3, 2002
I don't have a specific answer to your question but I do have sort of a
general one. Recently our support group went through a widespread panic
because one of our members received notification that WLS was no longer
going to be covered by BCBS and she shared this info with the group.
Fortunately for us we have a few BCBS employees in our group who explained
that it's very rare - almost unheard of - for insurance companies to
discontinue coverage across the board. Usually any discontinuation of
coverage is policy specific. For example your particular policy may stop
covering WLS but all United Health Care policies probably won't stop
covering it. Our support group member's BCBS policy was discontinuing
coverage for WLS but our other member's policies weren't discontinuing
coverage. It's my understanding that any discontinuation of coverage can
only occur at renewal also - they can't just stop covering things
midstream. Our BCBS folks told us to contact the customer service number
that's usually on the back of the insurance card and ask this specific
question "Does my policy cover gastric bypass surgery which has been
deemed medically necessary for the treatment of morbid obesity? If so, do
you anticipate that this coverage will change or cease within the next 12
months?" Supposedly if you ask it word for word just like this it
eliminates the possibility of misinformation from your insurance company
because of a loop hole. (for example they will tell you that surgery to
treat obesity is not covered but will fail to tell you that surgery to
treat "morbid" obesity is, etc.) Good Luck to you and remember
that NO doesn't always mean NO!
— ronascott
March 3, 2002
I hope not. I have surgery scheduled for 3/21/02. I am sure this is a
misunderstaanding. Contact your carrier directly.
— Ann O.
March 4, 2002
I have United Health Care and when I called them this morning to check on
the progress of my approval they told me that they are no longer covering
WLS as an ELECTIVE surgery. I told her that I'm certainly not electing to
have this surgery, I need this surgery - it is medically necessary and the
more tests I have done, the more potentially life-threatening problems
we're finding. I also told her that I had called them three times before
chaning to UHC in January and that I was told as long as it was medically
necessary then it was covered. I told her that changing to UHC had become
extremely expensive as I was with an HMO before and this is a comprehensive
plan. This is beginning to sound like a breach of contract situation if
they don't have it in writing that it is an exclusion but then make it one.
I agree with Rona, I don't believe they can do this across the board but
you know they'll try anything to hang on to every red cent.
— Vicki H.
March 4, 2002
Have you already requested approval for the surgery? If so, they may not be
able to deny you based on a change that takes place after your paperwork
was submitted to the insurance company. I would press them, get a
supervisor on the phone, and ask for the change in writing. Specifically
ask if the new exclusion applies to surgeries that were requested before
the exclusion took effect. Good luck.
— Mariee H.
March 4, 2002
I had wls .. open RNY in Dec 2000 , a revision due to a sld in April 2001,
and another revision due to an atonic pouch Feb 2002.. We are insured by
UHC.. Options PPO.. they have covered all three of my surgeries .. I was
approved within 2 weeks each time..
This is the first I have heard of this.. We have a bill in GA congress
that if enacted would prevent insurance providers from discriminating
against obesity surgical treatments..
— Gina Landers
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