United Health Care and Lap Band

I'm wondering if anyone has used UHC to get their lap band covered. I have been told by the insurance company that it's covered 100% (of elligible expenses, whatever that means) so I'm wondering a few things.

1. Anyone know exactly what the elligible expenses are or are not? I'm just waiting for them to tell me things like anesthesia and pain meds aren't covered or possibly the whole thing itself isn't "elligible"

2. Any tips for navigating UHC? From my limited experience they've been kind of hard to deal with. For example, when I log into my website (myuhc.com) it tells me that for bariatric services I must coordinate everything through a nurse line so I call that number and am told that I'm not elligible or enrolled or something and I have to call back the main UHC number. So I do that and am told again that what I really have to do is call the first number that I just got off of. And then I'm told an entirely different number to call that didn't even work. I'm lucky that my employer has a benefits hotline that I can call and get help when things like that happen. They straightened it out. But needless to say, UHC doesn't make me think they're going to be easy.

So... thanks!

I got my sleeve covered thru UHC and all means all - anesthesia and pain meds should be covered.

I had a hard time getting straight answers from UHC. I called to find out if we were required to attend 6 months of supervised nutrition classes and they kept telling me no. When i asked for it in writing they were unable to provide it to me.  I had to call my HR department to get it straightened out and it turns out we DO need the 6 month supervised diet.  I also suggest always going thru your benefits hotline as they 'should' give you reps assigned to your office and therefore, familiar with your policy.

Best wishes.

Thanks for the info. From what I've heard, I should only have to get my PCP to write a letter that she's been supervising my attempts to lose weight for 6 months (in actuality a lot longer than that) but that I won't need to do a new 6 month supervised plan. I will be very dissapointed if I do. 

Something to consider,, I had orginally thought about Lapband,, but my Endo suggested I go "all the way" I don't know how much you want to lose,, but with Lapband you still absord all nutrients (good thing) and all fats and not so good things. I personally know two women who had Lap band, one was extreemly successful one not. With something like RNY the malabsorbtion works for you in weight loss,, however,, you MUST do vitamins for the rest of you life because of the malabsorbtion.

Tom

Thanks Tom,

I am definitely set on lap band (or realize band, haven't decided yet) but won't do bypass for a variety of reasons.  I know lots of people who've been successful with both surgeries but I think the band is better for me. I'd be extremely happy losing 80-100 lbs and I don't care if it takes 3 years to do it cause I've never lost more than maybe 30, if that, on my own and definitely never been able to keep it off.

Glad it worked out for you though. And yeah, I met Dr. A yesterday and I really like him.

Ok, I was just pointing out the reasons I changed my mind.

Glad you liked Dr A, sometimes he takes some "warmingup" but is a great surgeon,, and person.

Tom

You will probably have to pay the copay for your room for each day your in which is $150.00 per day for four days and then they pick up the rest but you should only be in for 1 night so plan on that $150.00 as an out of pocket expense. I have MD-IPA but it is a division of UNC. Thats who I get all my letters from. Also they will not pay for intensive care if you need it. They really want you to do in and out but I don't know how they figure that. They are idiots believe me I have dealt with them on my surgery for almost 18 months. I fought them for the sleeve and they denied me 3 times for it then in January after I had Lapband surgery they started ok'ing it and believe me I didn't want the lapband at all. All of your in hospital pain mads are paid for. I opted for the lapband after I was denied and I didn't want it and January 4th of this year I was approved for Removal/Revision to the sleeve because the band port rejected. sorry don't want to scare you but as with anything it depends on the persons body.

I think it depends on the kind of UHC policy you have, I had either the lap-band or RNY covered (my choice) with NO 6 mnth supervised diet. My docs office submitted and I had an approval in 6 days and had not started the first pre-op appt yet. I had UHC-Choice.

I called the customer care line or support number and they were able to give me a pretty clear answer.

I've had a bit of a run around with the support number but that was a month ago before I had really started the process. I just checked and I am on "UHC EPO Club 100" plan, which is the one that offers NO out of network benefits but pays 100% of everything within network after a $150 deductible. 

I'm being told (by my surgeon's office) that they may or may not require the 6 month supervised diet, so apparently they haven't been asking for it 100% of the time. Either way, I'm submitting the paperwork for it to them cause I have been seeing my PCP for 18 months trying to lose weight and she is willing to sign whatever needs to be to help out.

Any idea what customer service number you called that was helpful? I swear the people I talked to didn't even know what bariatric surgery was and kept telling me that if it was medically necessary than it was most likely covered but I'd need a letter of medical necessity. Come to find out from my surgeon's office that I don't need that, just to fulfill the requirements before scheduling.

It was just the number on the back of my card. I actually have different insurance now, so I dont have that number handy.

I know that UHC has all the policy info online as well (well my policy did) what they covered what they did not etc etc but I never looked, my docs office found out everything for me in a matter of days. I really had to do no work, sorry I couldnt be of more help.