IS THERE HOPE AFTER ALL??

Time2StartLiving1107
on 11/20/13 5:07 am - Avondale, AZ

So I'm not sure if you remember but I posted a week ago about my policy with United Healthcare stating they will not pay for my surgery. Well I called another WL clinic and they called me back and stated although my policy shows that it's excluded, I still what's called General Surgery benefits, which may pay for some or all of the surgery. Before I get all excited about this. I was wondering what you all think. Is it worth taking a look into? Should I go sit down and meet with them. Tell me what you think

ABath
on 11/20/13 5:10 am - WI
VSG on 11/26/13

I don't think it would hurt to go an talk to them. I know if there was even a chance of having some of the costs covered I would make an appointment for as soon as I could get in. Good luck, I hope it works out for you!

 Height: 5'1" HW: 229 SW: 203 CW: 147.7

       

    
Time2StartLiving1107
on 11/20/13 5:14 am - Avondale, AZ

I guess it couldn't hurt anything :-) . Thank you, I think I'll go in and see what they have to say

hollykim
on 11/20/13 6:51 am - Nashville, TN
Revision on 03/18/15 with

it is all in how the surgeon codes the procedure. If he codes it as a partial gastrectomy ,which. The sleeve actually is,they might cover it. The concern I would have,is what would happen if I had complications. In my honest opinion,this is somewhat of an insurance fraud on the part of this surgeon.  I would have to think twice,long and hard and then think again,if I wanted someone who was willing to lie and defraud the insurance company,to do surgery on me ,just saying.

 


          

 

Time2StartLiving1107
on 11/20/13 6:54 am - Avondale, AZ

You made a valid point, one I haven't thought of. Thank you for giving me something to think about!

candiedtamz
on 11/20/13 7:55 am - TX
VSG on 10/22/13

For the previous comment...

I don't know about fraud as no doctor would put his practice at risk for any one patient. Plus, surgeons make lots of money on all the WLS's they do every year (I'm just saying). However, what I do know is if you get tested for a Hiatal Hernia via an Endoscopy before surgery, and it is found that you have one, your insurance may cover that whole procedure. When the VSG surgeon goes in to do the sleeve he would also repair the hernia so you would only be paying for the sleeve part of the surgery. This all depends on what type of insurance you have of course. I was a cash pay patient but I paid less because I had the hernia, which my insurance covered. Otherwise, I would have paid into the 10's of thousands. Good luck on your journey!

 

        

    
G5x5
on 11/20/13 10:42 am - VA

United Healthcare paid for my surgery (thank you very much UHC, LOL).

However, there could be variability from state to state and employer to employer.  The surgeons office will know because they work with the major payors and have to submit for payments.

No harm in cross checking though; however, it's unlikely alternate coding will fix the problem.  That's a dangerous area that could them in trouble and band from that payor.

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

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Time2StartLiving1107
on 11/20/13 10:44 am - Avondale, AZ
Thank u. I'm going to look into it.
puffierus
on 11/21/13 12:55 am - PA

It must be a state by state issue or maybe the type of policy your employer has. My co-worker fought with United Health care for 3 years to get WLS for his wife who has Diabetes, high blood pressure and has had two back surgeries and was schedule for knee surgery and they flatly refuse regardless of Doctors recommendations and comorbidities.  So he finally got a personal policy for her with Blue Cross and Blues shield and they approved the surgery right away. Of course the premiums were higher but over all a lot less than the cost of the surgery.

 

luckily for me my husband had Blue Cross & Blue shield thru his employer and they approved me right away.

 

good luck

 HW 268   SW219   CW 181.2 surgery date 10/31/2013

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Time2StartLiving1107
on 11/21/13 1:00 am - Avondale, AZ
Thank u so much and I was thinking about maybe looking into the Obama Care
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