Insurance question

I verifiied my insurance coverage with United Healthcare and in my policy obesity surgery is covered but the surgeon or assistant surgeon is not covered. Although my surgeon is an in network provider. This is an exclusion, has anyone else encountered anything like this?

How can they cover surgery but not pay the surgeon? That makes no sense. Or are you saying that your particular surgeon is not covered? Sometimes a surgeon can be a network provider for general surgery but not for bariatric surgery. If that is the case then you will need to find another bariatric surgeon, thats all. If it is the first case and they are telling you they cover surgery but will not pay the surgeon -- then that does not make sense. Now sometimes an insurance company will not pay an assistant surgeon, here again -- just find a surgeon that will work with your insurance company. Red

Hey Marjorie. I'm with Red. When I was first looking into all this about 2 1/2 years ago, I originally wanted to go with one surgeon. But my insurance only covered the facility, not the surgeon. So I just found one they did cover. Also, if you need more insurance help, a good website to look at is: www.obesityaction.org - you may find it helpful. ~ Monica

Marjorie, which surgery are you planning on and who are you thinking of using? As to the Assisting Surgeon, as in the Lap Banding. Dr. Rehnke as an example uses Dr.Grossbard as his assistant but Dr.Grossbard does NOT accept any insurance for his services, so any pateints must pay an extra $1000.00 cash out-of-pocket to recieve the Lap Band. Maybe that's what is with your insurance. Good luck. You may want to look around to other facilities too. Mike

I'm sorry, Let me rephrase it, they will pay for the hospitalization but not the surgeon or assistant surgeon fees. I will be having the RNY bypass at Town and Country Hospital with Dr A Fernandez. The coverage is listed under obesity surgery. I have confirmed twice with them. Both the hospital and the doctor are in network providers. This sounds crazy to me too...Thanks all

Marjorie, I have UHC and they covered surgery if medically nec. and the surgeon is in network so he was covered. I had the lap band surgery. The hospital I used was also in network. I had reached my deductibles so alot was 100%. The rest is 90%. I had alot of comorbidities and bmi of 48 . Good Luck. PJ

Hi Marjorie, I know what you are talking about. My insurance is only paying for the surgery and my stay in the hospital, but I pay the surgeon. I'm under my husband insurance and I called them sooooooo many times asking if they had any Doctor In-Network for Bariatric surgery and the answer was NOOOOOOOOOOOOOO. But yet they will cover or pay for surgery. It's a little confusing I know, but that's the way it is now. Good luck in your journey. I'm having surgery on the 19th and I'm very happy about it. But if you still have time take your time in asking around and go to the website that Monica gave you. Monica is very nice and knowledgeable. Have a nice day, Heidi

Wow, that is definately interesting coming from United Healthcare. I have United Heathcare and I was fully covered. My total out-of-pocket was $500 and everyone was paid (surgeon & assistant as well). Keep checking it out..if you need to change surgeon's let me know or check at the office at (352) 368-2828 and see if they can help there. Ask for Patrice.

Thanks a bunch for the info, and good luck Heidi on your surgery, I look forward to seeing the doctor, All my paperwork is in. I never knew the process was so taxing