United Health Care

Does anyone know how United Health handles lap band approval?  I called, and they said coverage is not particularly excluded, but the procedure does need to be approved.  I have an appointment with Dr. Ryder next month, but that's really my biggest question right now.

Very appreciative of any feedback.

Debbie

Hi Debbie,  I don't have United but I would suggest trying to get them to pinpoint EXACTLY what they will require from you to approve you.  My insurance had something called a Policy Bulletin that lists their requirements.  This will be the easiest way to determine what you have ahead of you regarding insurance approval.  Take down names and make good notes, and if they can provide you with something written, or point you to something on their website, so much the better.  Good luck.

Hi Debbie,

I have UHC...I am going for RNY. This is what I did numerous times...I called and explained that I was going to have RNY...then I asked if my policy had a Bariatric Exclusion...they said NO...that as long as they got a letter of pre-determination stating that the surgery was necessary(high BMI, other medical issues) that they would cover X amount of the surgery. I then if they require documentation of a supervised weight loss program and if so for how long. They told me that they do not require any documentation. Well I made this same phone call like 3-4 times. I got the same information every time I called to my surprise.

-Rob

Thanks to you both for your thoughts.  Tough making calls during the day from my work cubicle, but I'm off Friday, so I'm going to start implementing your feedback.  Thanks again!

I ended up calling twice -- got the same "it's not excluded but requires letter from surgeon and pre-approval from UHC".  Of course I was naive enough to not write down the second call -- when and with whom.  Had my first meeting with Dr. Ryder on 8/25 (who, oh by the way, is TERRIFIC!).  On 8/29, UHC called the doc's office and informed them I have an exclusion on my policy.  I call UHC -- "yes ma'am, I see where you were told pre-approval is necessary, but you have an exclusion on your policy".  He was unable to provide me the name and address of someone to write to to complain about the misinformation - just a POB in Salt Lake City.  Now, I wonder, how do I find out the answer without divulging details.  Go to HR and relay the story, minus the details.  "How do you know who is correct, Deb?" she asks.  She hooks me up with her UHC rep (waiting for a call back -- hopefully Tuesday) and gives me the name of someone in Warwick to write a letter to.  That's already gone out FedEx.

When we switched to UHC on 1/1/08, we were not given hard copies of the summary plan description.  We have to rely on the website, which only mentions an acupuncture/alternative treatment exclusion.  So, Tuesday I have to go back to HR for a hard copy of the plan documents.  Maybe that will tell me something.  If not, I have to hope I hear from one, if not both, of these people on Tuesday.  I know if it's an exclusion I stand little/no chance on appeal.  If it's misinformation, we move on.

Am I missing anything in an effort to get my ducks in order?

Deb- I wish I had an answer for you, but I don't.  I was incredibly lucky to have had such an easy approval.  I know there is a board for people with insurance problems- I would check it out and see if anyone there can help.  I wish you all the luck!!!

I had the same thought earlier today -- to see if any of the insurance gurus had any thoughts.  I just posted an inquiry there.  Thanks!!