What is up with this?

Ok i just don't understand insurance companies lol I have UHC and i have a written exclusion but i just saw that Robin Blackstone is in my book of doctors that are ok to go to! So i was looking on here for info about here because i thought that maybe she also worked at a hospital. but it says that her practice is focused entirely on Weight Loss Surgery. So if they don't cover WLS why is she in my network of doctors? I don't get it! Is that a loop hole that i just found? Any ideas people? Billie Jean PS there is a lot of doctors that do the WLS that is in my network! How can that be?

Hi there. I will try to answer your question. The book that is printed for UHC providers is the same for all thousands of employers that have a contract with UHC, they don't make separate books for each employer. All that means is that they are contracted with UHC. Unfortunately the fact that your ins has an exclusion does not relate to the Dr. contract. Please research how your exclusion is worded. Maybe there is a loophole. Good luck on your journey. Paula Open RNY 4/1/4 330/195/ still working at it!

.....simply because you have a UHC boolet and she accepts UHC. Your exclusion is written in by your specific employer. That's crummy news! ......consider financing? Good luck! Joyce

I have united health care and was approved 1 week after akk my information was submitted. I am scheduled for surgery on Dec 26th. Karen is the program cordinator for DR Schwartz and there are many patients @ the program I am going through that have exclusions on their insurance plan put Karen was able to get them approved the 2nd time around. You should give her a call its Foothills Surgery PC 4530 East Camp Lowell Tucson AZ 85712 The office is located on Swan and Ft Lowell They also refered me to a new primary care dr since my regular PCP dropped me and refuses to treat me because of my decession to have the surgery I have my 1st apointment with them on the 15th Its called Camp Lowell Medical Specialsts.

Thank you for the info! I am going to give her a call on Monday. Thanks Billie Jean

I have UHC and although there is an exclusion claus there is suppose to be a way around with medical necessity. however, I had three medical necessities and still did nto get it. I went to Mexico and had the open RNY with Dr. Aguirre. paid out of pocket. because my primary Dr. siad it would be a health benefit for me I get to take the whole cost off in taxes.

So was you worried to go to Mexico? I don't know why but going to Mexico kind of scares me. How much did it cost? Anyways thank you for the reply' Billie Jean

Whatever you decide, do not go out of the country! If you have any problems after, you won't want to keep going out of the country and doctor's here may not be too willing to step in. I think the cost here, versus out of the country is only part of the consideration. I read about one girl who had lab band in Mexico, needed a fill here, and they were going to charge her $750 for that fill. When a doctor here does the surgery all the fills you'll need over 1 year, (it's not just 1 fill) are included in the cost of the surgery. Plus, there are pre-op classes as well as post-op educational sessions you need to attend so you are informed about all aspects of the process. If you should pick up infection with having it done out of the country you'll really be in trouble, your ins. here will more than likely not cover it. We have UHC and even though the plan said it doesn't cover WLS, if you have the correct diagnosis (the ins. co. will tell you what it needs to be) from your primary care doctor, ours approved us, first time submitted. Our doctor is Robin Blackstone, Scottsdale Barriatric Center, she is excellent. My husband has had his without a single incident and mine is coming up in January. If you have to pay for this yourself and your a homeowner, you can easily obtain a credit line and most doctor's will give you some sort of cash discount. Good Luck and stay healthy! CaroleM

What do you mean the correct diagnosis? And why would the Ins co tell me? don't they want to save them self money? How much do these places charge for the WLS if you pay out of pocket? I have 24,000. in my 401K if i have to take a loan out on that i will. But i don't know how much they cost so i might not even have enough to pay out of pocket.

Ours was morbid obesity which has a certain BMI ratio. I think it's around 40+, some of the bariataric web sites will help you with it. Ours was Scottsdale Barriatric.com and Robin Blackstone is the doctor. She's on UHC approved surgeons list. THe cost depends on which surgery. We're having lap-band. I think the web site might tell you the cost. It's the least expensive and I think the best, but you would have to read about the different ones to decide for yourself. I'm pretty sure you have enough for lap-band, but check on the site I mentioned. There might be similar info on this site as well. I have never seen a bill so I can't tell you exactly what the cost is. We only paid 475 at the time we filled out our package and had our letter from the primary care doctor. That's all I've ever paid, all the other tests have been billed to the insurance co. and they've paid everything. We've been very lucky that way. Hope this helps. CaroleM