Insurance troubles

Hi I've been trying to have the lap-band procedure with Dr. Roye, but have had a terrible time with United Health Care. Has anyone else had to deal with them? Did you have problems? I'm grateful for any help. Thanks, Patty

I heard from someone else that they had an exclusion. Is that the case with your insurance? Betz

Hi Betz, No, there are no exclusions...they use the "must be medically necessary" clause to pick and choose what to OK. I've been searching many WLS forums and foung that UHC has a history of denial where the band is wanted. They seem to be more willing to approve bypass, but still make you jump through hoops. The 6 mo. physician supervised weight loss "requirement" is a big bone of contention for me. On another site, there's a woman who has almost completed the 6 mo. requirement. She has now found out her insurance will deny her because she's been so successfull! She's lost under 25 lbs in almost 6mo., has 100+ more to lose, and that's too successfull??? Her insurance is Cigna. Thanks for listening, Pat R.

Sorry to be so rude but United helthcare SUCKS!@!!!!! I can't say it enough.... I was rejected, appealed, rejected, appealed, and then rejected again!!! This was after talking to one of there reps to make sure I would be covered by them first, before even going to the dr. to see if I was eligable for the surgery...... The first time the dr.s office put in the approval request I was denied.... for breast reduction surgery!!! Those bumbling idiots at UHC screwed up and somehow got Lap band mixed up with Breast reduction.... I can't even think of how they got the two of those screwed up. In the end I switched to Healthmate coast to coast and was approved right away first time out... they have been great!! They covered all the pretesting (w/ co pays of course) and have been nothing but helpful and kind. So to answer your question "Yes I have dealt with UHC" and "Yes I had many a trouble" For the appeals, I had a letter from my PCP, Dr. Roye and my nutritionist and one that I had written myself to inform them of how this surgery could save my life.... they couldn't care less because it would effect there bottom line.... someone should really remind them that they are a health insurance comapany, and we PAY them to insure us for when we need surgery....how is it ok for them to reject us??!! Sorry I didn't mean to rant I guess I'm still a little ; ) annoyed with them... ok if you are unable to switch healthcare companies I would just appeal, appeal, appeal again and again until you annoy them enough that they give in..... that has happened before. If they still reject you just don't give up....this is your life, don't you deserve to live it? ~E

I decided to attempt to change insurance carriers before I made the original post. I was told it could be done, but it could take up to 45 days. I got the letter in the mail yesterday, insurance carrier will officially be changed on Monday 2/26. I will have the dr's office resubmit all the paperwork then. After all the crap I've been through with trying to get approval, this change has gone through very smoothly. Almost too smoothly. I'm so jaded by the experience that I can't trust, or believe something good my be happening! Patty