Need feedback on United Health Care NC

Hi all - I need some feedback (as much as possible) from any of you about United Health Care in NC and their coverage of WLS.

Background:  My surgeon's office (Dr. Enochs office) phoned the insurance company on March 9, with my group and policy numbers, and was told by the representative that they covered (if the patient met all criteria) at a 70% rate, and that I would have to pay a $1000 deductible as well as 30%.

A little over a week ago, I phoned my insurance company prior to my surgeon's office sending in my packet and was told that my company policy did not include WLS of any type.  The surgeon's office called the next day, and they told them the same thing, hinting that my company had opted out of WLS coverage.

I have spoken to my company today, and THEY tell me that they did NOT opt out of anything.  They called UHC, and were told that it was not my company that opted out (three different stories from them already), but that United Health Care as a company does NOT cover WLS of any kind.  What???  You're really kidding me right?  How can that be, that the company as a whole does not cover WLS, when I know many people who have had WLS with United Health Care?

So my question is, have any of you with United Health Care in NC had this same issue?  Have any of you been covered by United Health Care for your WLS?  It seems awfully fishy to me that they are saying that they don't cover WLS at all, companywide.  That's ridiculous. 

Have you seen this? https://www.urnweb.com/gateway/public/bariatric/bariatric.jsp
They list their centers of excellence.  That to me inplies coverage.. right?

Good luck.
Kelly

Keep digging. I have UHC and so does my husband. I was covered for my surgery in 2007. My  husband was covered in 2008. His company decided to opt out of any WLS coverage effective 2009, but that was a corporate decision, not a UHC decision. 

Try cross posting to the main, RNY and insurance forums to see if you can get any other more recent coverage experiences... I'd try the LapBand forum too because I'm sure that they cover that as well.

Best of luck,

Well, UHC might cover, but I've talked to them and to my company, and gotten a copy of the policy, and it expressly denies any coverage for Bariatric surgery - the company says it wasn't them that opted out.  UHC says they don't cover anyone (which is a lie, and as Kelly has pointed out, they even have a "centers of excellence" page. 

I'm not sure what to do at this point, but how do you appeal if you don't even get a chance to submit?  UHC sent me the policy - it says that it does not cover gastric bypass or any other weight loss surgery (this was not shown to me when the company switched policies).

Looks like my only chance is to try to get them to allow me opt out (open enrollment was in march and won't happen again til next March).    My company is looking into finding a loophole to get me out of paying so I can just pay for my own personal BCBS policy, which WILL cover bariatric surgery.  OY!

I don't know alot about United Health Care but do know that there are many people that are not covered by them due to company's have to purchase the ryder for Bariatric WLS and many do not buy.

If you purchase a private BCBS policy from Blue Cross they also do not cover WLS because the private policy does not cover this. I know this because I had the private policy and they do not cover the WLS. Please research before you opt out of the UHC policy and then find you will not be covered with the private policy.

Tamara

Kristi,

Go to the insurance forum and post. Also keep checking with UHC. You are likely to get different information from different representatives. Not fun, but often true. 

Keep digging. We were originally told that Ben's policy had a specific exclusion for bariatric surgery on multiple occasions. We kept at it and found they were in error.

Wishing you all the best,

I also have UHC, but only as secondary coverage.  When I contacted them to see if they covered anything with WLS, I was told the exact same thing that you were.  I have several other experiences with UHC not wanting to pay for other services, you have to stay on top of them.  Each time you call you will get a different answer.