New Member Needs Some Advise

Hello! I'm new to the Missouri board but have been crusing the main board for quite some time while I researched Lap Band Surgery. I've never posted a message before, so if the questions I'm asking sound a little strange, please bear with me until I get the hang of it all. I have both Cigna (my primary insurance) which does cover my bariatric surgery and Medicare (as my secondary). I recentely attened a seminar and filled out all the application forms and submitted them to Dr. Hitch**** and Dr. Hoehn at Shawnee Mission Medical Center only to have them returned because Medicare is my seconmdary and they (and the hospital) are not yet designated as a Center of Excellence. I am really confused (and disappointed)! If my primaary will cover all of my expenses (and Medicare does not allow pre-certification anyway); why was I told that I would have to go to a Center of Excellence when Medicare is not the primary insurer? Has anyone else come across this problem? I would appreciate any help anyone out there can give me and any suggestions on hospitals or surgeons that may take my insurance(s). Thanks in advance. From what I've read, I think you all are great!!

Dont know why since i would think they could use the primary ins but the only Hospital in the state of Missouri is in Sedalia that will take Medicare. They are the only one that has their certificate of Excellence. I know that Dr. Hornbostel will accept you as a patient. I know it is a little ways from your home but is the only solutinon that I know of for you at this time. By this time next year there will be more Hosp. certified im sure but as for as now no there isnt. . Hope this will help some. Jan

If your primary insurance will cover it, do you necessarily need to throw Medicare in the mix? You might pay a little more out of pocket, but you could have the surgeon of your choice. Call the surgeon of your choice, and ask someone who deals with insurance about how all that works and if you MUST use your secondary insurance or if you can leave that off. Good luck! Pamela

I had unitedhealthcare for primary insurance and medicare for secondary when I had my surgery in October 1, 2003 and after unitedhealthcare paid I guess medicare did too as I never got any bills. My wife had her surgery six months after me and she only had to pay about $2,500 out of pocket. If they primary insurance pays I would have my surgery. If you want to play it safe you could go with Doc Hornbostel and you know you would not pay to pay anything.

Hi, I wanted to ask you something. You said you have United Healthcare Insurance. My husband has United Healthcare and they don't pay for WLS. What's the difference? If you could help me I would be more than Thankful. I have Medicare and I'm getting WLS on August 17th. My husband also needs to have it, he has type II diabetes pretty bad and High blood pressure, and needs to lose about 130 pounds. Thank you Brenda

Hey Brenda, I know you posted the question for someone else but I thought I might be able to help. From what I understand... insurance companies have different policies for businesses to choose from, some of those policies cover WLS and some don't, it's up to the business who purchases the policy to decide what type they want. There have been others who have had insurance thru a company who's been known to cover WLS but their specific policy didn't cover it. Lia

Brenda, I depends on how the company set up their exclusions. The company that I work for doesn't have any exclusions so United Healthcare approved my surgery with no questions asked, whereas some others that I know that have united Healthcare have been denied time after time. So nothing else, have your husband talk to his HR dept to see the policy himself and find out what exactly they have put down as their exclusions. Nothing else if he can get a copy of that then your dr might be able to look on there and see if there is a way around it to get the approval done.

sorry about that I was trying to send this to David Wilson Thanks

Thanks to all of you who took the time to reply to my questions. It's interesting that I got a reply speaking about United Health Care because my husband's company was just bought out by another company (effective 7/1/06--only 5 days away) and absolutely nothing has come out of the front office regarding insurance or other benefits. The RUMOR has it that United Health Care will be taking over, but no specifics will be given out until Wednesday 6/28/06. There should be a law against keeping workers in the dark like this. I just found out today that my Primary care Physician does not accept United Health Care. I've been with her since 1997 and I really don't want to switch, but it's either switch or go out-of-network and I'm not sure we can afford that. As far as not listing Medicare as my secondary; the first doctor's office (Dr****ch**** and Hoehn) told me that it would be insurance fraud if I didn't list it (why I'm not sure since Cigna would have paid the full ride). His staff also indicated that the Doctors were trying to decide if they would continue to accept Medicare. Why, I wonder, are they putting in for the COE with Medicare if they plan to drop it? Anyway, I will keep you all posted about whether or not the United Health Care plan we get (IF indeed we do get it) covers WLS.

Theresa~ Hang in there. Dr. Hoehn's office will do what they can to get you approved. Hang in there. Nola can work wonders for you. Keep your chin up and things will happen. If you have any questions, don't hesitate to ask...that what we are all here for. Good luck... Stephanie