Well my WLS plans are going to be put on hold for awhile

I just called my work and found out that we are no longer going to have United Health Care Choice Plus as our Insurance provider. Which is good i guess because i have been on the phone all day with UHC and i am getting the run around. The first time i called i was told yes that all forms of WLS is covered as long as it is medically necessary then i was i get disconnected so i call back and was told by a different lady that no it is not covered and when i start asking questions i get disconnected once again. So i call back and talk to another lady. I was told once again that it was not covered and when i start asking the question the most amazing thing happened lol I get disconnected once again. Ok so by this time i am getting :-@ ticked :-@, so i call back again and this time i am told i am covered and when i when i ask if i can get that in writing the phone goes dead again. So you guessed it i called back and guess what they told me this time :-@! I am not covered and that the only way i can change my coverage is by going through my employer. So i call them and they told me that UHC lied that they have tried to get WLS covered :deal: for the past 3 years but UHC would not allow it :-S. So now i guess i just have to wait and see who the casino picks up as there new Insuance provider :sniff: :'( :sniff:. And then next May - June will be our open enrollment so what do you do :shrug: ? Billie Jean

Billie Suggestion ..... Start on supervised diet with your family doctor now ! that way when you get your new insurance - your a step ahead - since most companies require 6 month supervised weight loss attempt .. Positive thought - its worth the weight and the extra hoops you have to jump through,

Sounds like a BS to me! hehe I would still go ahead with the workings of getting everything started. You have until May of 2007? that is plenty of time! Like most insurance companies they require Letter of Medical Necesscity, documentation of past weight loss attempts (Weigh****chers, Jenny Craig, gym memberships, etc) and like Jeanna said I would start getting some documentation from PCP of 6 months supervised diet. At least get the ball rolling so when it comes time to open enrollment you have everything taken care of.

I have nited health care and was approved a week after the nurse @ the sergeons office sent it off. I was shocked it was so fast. I see your from Tucson where are you getting your sergery?

Billie Jean, UHC DOES cover WLS surgery!!! They cover both the lap-band and the RNY gastric bypass if medically necessary. I also have UHC Choice Plus and was never hung up on, but never could get a straight answer either until after I got approved. Your employer determines what type of WLS surgery and what criteria you have to meet. My good friend and I both have UHC Choice Plus, but work for differnt companies, and she had to do a 6-month diet, but I didn't. When I asked UHC how they determine what criteria you have to meet, they have the standard medically necessary 35+ BMI with 2 co-morbities or 40+ BMI with no co-morbities. When I asked why I didn't have to go thru the 6-month diet, I was advised that my employer can set additional criteria that needs to be met before being approved. I know this can be very frustrating, but this is your benefit and you have a right to know your exact coverage. Going forward, since your company is changing, ask for a supervisor immediately if you ever get hung up on. A lot of companies now monitor the customer service calls, and can track that if you let them know when you called and who you spoke to. Always get a name up front, and keep a record of who you speak to, and at what time. Then ask specifically for your company's EOB (explanation of benefits) or COB (coordination of benefits) this is the written document of what your employer has decided to cover for you. This can be a very frustrating experience dealing with insurance companies, but this is a benefit that both you and your employer pay for you to have, and you have rights as a customer. I'm sorry to hear that your employer is changing, because although UHC i**** and miss sometimes, they processed my claim very quickly, and I was approved within several weeks. If you insurance doesn't change until May, I encourage you to get on the phone with UHC again, and ask to speak to a supervisor. If you need help, just let me know, I love talking to them!!!! I wish you the best of luck on your continued WL journey, and keep us up to date on your progress. Alli

Well that is what the first lady said that it was covered as long as it is medically necessary, but then the next said no. And then UHC said its my employer who says what is covered and whats no and then my employer said that UHC would not allow them to add it to the policy. The lady i talked to at my work said they have anywhere from 25 to 50 people a year asking if they will cover WLS and that they have tried getting it but they just can't. She said when they start shopping around for a new provider they are going to try to have them add WLS to there coverage. I see people who have been approved for the WLS even though they had a written exclusion in there policy. But when i talked to UHC she said i can appeal even before i am denied. She gave me a address in utah but then she said i can only appeal 3 times and since there is a written exclusion i would just lose the appeal and that if enough people did that then my employer would have to pay then in the long run they coverage would get worse and we would have to pay more. So i don't know if she was telling me the truth or if she was just giving me the run around. So anyway from what the lady at UHC said i basically can tal****il i am blue in the face but they still won't approve the surgery. I just don't know what to do! Should i still try to get the approvel through UHC or wait and try the new company thats coming in. I just don't know why they don't approve it. If the insurance companies would just help people with there weight right now then it would be cheaper in the long run. Anyways i am going to try to find a doctor that is understanding about weight issues so i can start the supervised diet stuff. Does anyone know of a good doctor on the southside of tucson? I am not from AZ so i really don't know my way around Tucson. I pretty much stick to the southside lol. Thanks for all the info! Billie Jean

Since you are changing insurance carriers in May anyway, you've got nothing to lose by trying to get United to cover it now. No matter what insurance group you have, the surgeon has to submit for coverage anyway so I would take Ali's advice and start working with your pcp now on the diet, then I would start working with the surgeon you are going to use and have them submit to UHC. If UHC denies it (and they probably will) they have to specifically tell you why. You'll know then if it's excluded or because of some other technicality and you can appeal the decision, no matter what the reason. If you bomb out with United before you change carriers, you'll have most of the stuff you need ready for the next round. If you get approved before the carrier change, maybe your surgeon can fast track you and get the surgery done before you change carriers. Connie