NOT COVERED BECAUSE I WORK FOR THE INSURANCE COMPNAY??

Time2StartLiving1107
on 11/14/13 4:26 am - Avondale, AZ

So I received a call from the surgery center and they stated my insurance (United Healthcare) doesn't cover any weight loss surgeries for their employees. Can my doctor request that I get it because it's medically necessary or should i just stop wasting my time? :-( I feel very discouraged about the whole thing.

claimmaster
on 11/14/13 4:31 am - OK
VSG on 07/05/13

Your employer is the one who makes the decision about what is and is not covered under your plan.  One thing that makes it cheaper is to not cover bariatric surgery.

My insurance covered it, but I didn't want to go through the hassle that the insurance carrier would put me through, so I was self pay and went to Mexico.  It'll take me a bit to pay it off, but it is so worth it to me.

Jane

 Starting weight: 320       Goal weight: 145      Surgery Weight: 298      Current weight: 215         Check out my blog at www.thebariatricvegan.com

Weight loss month 1-22  2-13  3-12  4-16  5-4  6-0  7-7  8-6

   

    

Time2StartLiving1107
on 11/14/13 4:35 am - Avondale, AZ

Hi Jane,

Thank you for your response. I just feel so upset, I pay an arm and a leg to have this insurance and to think they are going to provide something I truly need makes me upset. Do you mind me asking how much you have to pay if you chose to go to Mexico? And how would I go about that?

claimmaster
on 11/14/13 5:18 am - OK
VSG on 07/05/13

I paid $6800 for my surgery.  That included everything but the plane ticket to get there.  This is the group I went with, and I was VERY pleased with the entire experience.  It's OK to get in touch with them.  They don't hassle you with phone calls after you contact them.  It's up to you whether or not you want to go with them.  There is a Mexico forum here on OH, too, and you can get more recommendations there.

http://www.beliteweight.com/index.php

The only thing about going to Mexico is that you'll need your PCP to do any follow-up labs.  My PCP was totally on board with the idea.  I used this OH site as my biggest source of information.  I don't regret a thing.

Jane

 Starting weight: 320       Goal weight: 145      Surgery Weight: 298      Current weight: 215         Check out my blog at www.thebariatricvegan.com

Weight loss month 1-22  2-13  3-12  4-16  5-4  6-0  7-7  8-6

   

    

Time2StartLiving1107
on 11/14/13 5:23 am - Avondale, AZ

Thank you Jane for your information. I will def look into. I'm also talking to other people who are telling me that although my plans EXCLUDES the WLS I should still try and if denied to try to appeal it. So I think I'll do that too :-)

G5x5
on 11/14/13 5:58 am - VA

Agreed with the above response.  If your plan doesn't cover it no amount of complaining, appeals, etc. is going to change that.  They do that to avoid cost and you're out of luck.   Sorry.

leave it to the insurance company t be the stingiest of them all.

HW: 255 (6/5/13), SW: 240 (6/19/13), CW: 169 (9/16/14)

M1: -26,  M2: -17,  M3: -5,  M4: -13  M5: -12  M6: -11  M7: -8

M8-10: Skinny Maintenance (10k Training)   M11-13: On Break

M14+: **CROSSTRAINING FOR ALL AROUND FITNESS**

Google NSNG and learn the right way to eat each day

Time2StartLiving1107
on 11/14/13 6:03 am - Avondale, AZ

It's just really sad to know that they wouldn't care about some ones health. I pay them way to much to not be able to have my needs met. I think I will start looking for a 2ndry insurance soon.

hollykim
on 11/14/13 8:07 am - Nashville, TN
Revision on 03/18/15 with

sadly,they don't care aboutnYour health or anyone's health. It is a business and they are most interested in  putting money in Their pockets. The Less they spend on policy holders,the more can Go in their pocket. 

No amount of Appeals will get them to cover the surgery if it is excluded. They ha vEnt paid the extra money to buy the rider for their employees so they won't pay for it. 

I second MX.

GL

 


          

 

TurnThePage
on 11/14/13 6:15 am

Check with your employer's insurance administrator to verify that bariatric surgery and treatment is excluded from your coverage. If it is, there is nothing you can do to change that possibility. Not every insurance policy covers every medical treatment. For example, virtually all policies exclude most plastic surgery and particularly when it is to rectify problems that arose after bariatric surgery. They are considered elective procedures. Sorry, but that's that way it is.

If you do decide to look for alternate insurance coverage, you might have luck finding something less expensive through the insurance programs offered under the Affordable Care Act. I have had UHC coverage for 12 years, but will save close to $400 per month by switching to Blue Shield under the ACA and still have similar benefits. 

I think the average cost of RNY is about $20-$25,000 in the US. That will cover a lot of insurance premiums, but you have to very carefully check out the benefits and terms of coverage before you take on a new plan.

Time2StartLiving1107
on 11/14/13 7:12 am - Avondale, AZ

Thank you so much I will be looking into that ACA. Because I'd rather have a different insurance and be able to save if i can. I will look that information up online tonight

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