Insurance Games

I have done all my preliminary testing/requirements to have surgery at OSU but have been denied three times by UHC because of a nasty exclusion in my policy. I am working with an attorney, but here is my question and something that just occurred to me this evening...should be excited about Christmas, but all I can think of is how unhappy I am cause I cant seem to win this battle...anyway, just wondered if I might have a better chance getting approved with another facility/Dr. with better rates. OSU's costs around $40K and Dr. Curry, for example is around $16-18K I think. Maybe Tracy (from Dr. C's office) or someone might have an opinion on whether the higher cost of my surgery at OSU is making it harder for me to get this overturned. Please comment, please.

The exclusion was selected by your employer, so if you haven't already, I would recommend working with the HR department and see if they would be willing to put pressure on UHC. I was one of the fortunate to have an employer that purchased the rider to include WLS for UHC. With that, they'll cover any procedure.

Where you are having the procedure does not matter. If it is in network then your insurance company doesn't care. They aren't going to give OSU $40K anyway. The insurance company has a pre-negotiated contract rate that they are willing to pay. I started with a different surgeon/center and had to work my butt off to get approval. Then they dropped me. Trust me, if OSU can do anything to help get you approved they will. Unfortunately, you need to put the heat on the employer through which the employer was purchased and kindly ask them to consider purchasing the rider for their policy. Even with the rider on my policy I was denied originally due to insurance games. Much success with your journey!! Blessings, Jacq

I completely agree with the post above. If you came to our office and had a policy exclusion, I would advise you to seek legal counsel or consider self paying. Depending upon the wordage of your exclusion, an attorney may find away around. Our price for the Lap Band is $16,500 and includes basically everything related to the surgery and 1 year of adjustments post-op. The company that makes the band has a financing program that you may wish to call at 1-877-lap-band. Our price for the RNY is $19,500 and as with the band, covers most everything related to surgery and 90 days of routine post-op care. It sounds like you are on the right track now by seeking legal counsel. Hopefully you chose an attorney that has had experience with these kinds of cases before. Good luck!! Tracy Burch Insurance Coordinator Dr. Trace Curry's office 513-559-2544 [email protected]

Actually, my insurance is through my husband's company, which he owns. At the time he got the policy, he didnt pay attention to whether or not WLS was covered because we had never discussed that I might someday be willing to have the surgery. Now we are not able to add ANYTHING to get it covered. The reason is because my husbands company is small and to get a rider added for this you have to have about 150 employees (cant remember how many exactly). I have even looked into dropping UHC and going with one that covers it, but I cannot find a company that has WLS as a covered benefit for small companies. They are all telling me that the only companies that get it covered for their employees are ones that are really big. My husband only has about 20 employees, nowhere near enough. I am really frustrated. I dont see this happening. We could change to any insurance carrier we want, but the insurance companies dont want to cover it for small companies. If anyone has had any experience with a company that covers for sm all businesses, please let me know.