Recent Posts

Jewel_in_hiding
on 11/29/10 10:26 am - Raleigh, NC
Topic: RE: UHC (united) billing weirdness and lagging on approval...
Without knowing the specifics of your plan it is hard to figure out what is going on. Do you have a deductible that needs to be met? what is your cost-share?  UHC usually processes my claims within 48 hours. I would suggest looking at your EOBs (Explanation of Benefits), you can access them online, and see where the amount you owe is coming from.  There is also the possibility that the insurance company wasn't billed correctly. Then take a look at your coverage, if you disagree with the way they have applied any of the billing/payments, then appeal. I know I have a deductible of $1250 so I was responsible for some of my pre-op testing. 

As for your approval, call UHC. 3.5 weeks is a long time for them. Its possible that something is missing and they have contacted your surgeon (either via phone or in writing). However, you will not know unless you call them and ask.
Top is my progress, Bottom is to Surgeon's Goal
  
         
    
Jayne
on 11/28/10 10:31 pm - Swiftwater, PA
Topic: My Empoyer's Plan vs my stoma
My employer's healthcare plan specifically states one bariatric procedure per lifetime. However, my surgeon has stated that I require a Band Over Bypass to correct a dilated stoma (staples came out of place )....  The insurance rules this BOB a second bariatric procedure not a correction to the RNY....

Has anyone had any experience appealing for an exception/waiver to the Empoyer's Plan???
roxyroad
on 11/28/10 9:45 pm
Topic: UHC (united) billing weirdness and lagging on approval...
I don't know if this is happening to anyone else with United Healthcare but they're really ticking me off lately. The insurance coordinator at my surgeons office told me their rep said all the pre-op tests were covered under my plan.... yet I got a bill for about $1200 of tests they completely did not cover... WTF. And my paperwork was all submitted about 3.5 weeks ago and still no response. I've seen some people on the boards talk about UHC having a quick response and being easy to work with, so this is a bit frustrating.

Is anyone else having similar issues with UHC lately?
Amy O.
on 11/28/10 4:13 am - Dundalk, MD
Jewel_in_hiding
on 11/28/10 2:19 am - Raleigh, NC
Topic: RE: United Heath Care
I have United Healthcare and VSG was an option for me.  However, whether or not your brother's plan will cover it is dependent upon his employer. His best bet it to call them and see if his employer has purchased the "Bariatric Resource Service" through UHC. If so, he will be assigned a case manager that will walk him through the entire process including fast tracking the approval once all the paperwork is in. 

Good luck!!  
Top is my progress, Bottom is to Surgeon's Goal
  
         
    
jhiggins5377
on 11/27/10 10:26 am - Rittman, OH
Topic: RE: Aetna Approved
Thanks Nan. Wish the best of luck to you and your family with your WLS.
Nan2008
on 11/26/10 9:14 pm - Midland, MI
Topic: RE: Aetna Approved
CONGRATULATIONS on your approval!  You are right, there is nothing better than that phone call saying you are approved.  I still remember the day I got the call.  I also have Aetna.  Myself and my daughter have had surgery and my two sons are having surgery December 13th!! 

Good Luck to you!  Let us know when you get your surgery date!!

Nan

Nan

HW 300
/ SW 280 / CW 138 /
GW 140
Hit Goal 4/2/2010

        
RoylynnW
on 11/26/10 1:37 am - Bryan, TX
VSG on 06/05/08 with
Topic: United Heath Care
Howdy , Does anybody know if United Heath care covers VSG. My brother  told me yesterday that he is ready to have the sleeve. If United does not cover it I will write the check my brother means more to me that 10k. does.....  Hope you all had a great Thanksgiving... God Bless
nascar24n48
on 11/25/10 6:38 am, edited 11/26/10 5:01 am
Topic: ICD-9 Codes
I need the list of insurance codes for blood labs. Think VitaLady had one but I can't find it now. I remember being told to make sure the insurance does NOT use "Surgical Malabsorbtion" since some policies do not cover anything related to WLS.   I have Blue Shield HMO and want to make sure its gets paid. They have paid it before but with all the talk about the insurance reforms I would like to get my PCP to use the code thats "more acceptable."  Can those of you who have great success getting your labs paid post the ICD-9 codes used for insurance coverage?

Preop 242  Height 5'4"  Current: 145 Want to get back to 135. ZERO Complications! ZERO Vomiting  (Chew, chew, chew)! ZERO Regrets!

WASaBubbleButt
on 11/24/10 11:33 pm - Mexico
Topic: RE: denial from cigna?
Are you actually using a C-Pap? Meaning, were you diagnosed with mild sleep apnea not requiring treatment or was it severe enough they gave you a C-Pap to use every single night?

Previously Midwesterngirl

The band got me to goal, the sleeve will keep me there.

See  my blog for newbies: 
http://wasabubblebutt.blogspot.com/
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