Anyone out there successfully convinced their employer to add bariatrics?

Hi There, I am new to Obesity help and have found a wealth of very helpful information. I am going through the insurance struggles that so many experience and although I am trying to stay focused and move forward with force, I am getting very frustrated. I have United Healthcare and although UHC is known to be a supporter of Bariatric services the employer must opt for the obesity treatment rider. My employer recently changed to UHC from Sagamore and as soon as that change happened I called to verify that Bariatric services, specifically lapband (cpt code 43770) was not EXCLUDED under my group health plan - they confirmed it WAS a covered benefit and not once or twice, on 4 occasions (all documented). TO shorten the story, I recieved a letter of denial based on an exclusion after being told several times by UHC customer service reps that it was covered so I was misinformed, mislead, run in circles etc. I have been going in circles with UHC and they have admitted in email that it was their fault and they located the descrepancy and corrected it so no one would be misinformed again - lovely however that does not fix my situation of give me back the time and out of pocket expenses encurred during the process so still I am going in circles with them. I have been advised by my surgeon's office to go forward and propose to my employer to add coverage for bariatric treatment. I have written a letter, have a wealth of information to attach and my surgeon has also offered to go to my employer and give a presentation (I have a GREAT surgeon) to explain the benefits of LapBand. Is there anyone out there that has sucessfully convinced their employer to add obesity treatment to the group health plan? I work for a relatively small company and hoping that will work for me. Miriam - Indiana

I am so sorry you are having this problem and hope all gets straightened out. Could it be possible the exclusion is for the band and not the RNY? The reason I ask is because my insurance covers the RNY but not the band and I know there are several other policies the same way. That may explain why you were told that WLS was covered the first time. You might call back and see if RNY is covered. If so, maybe all the expenses you were out would also be covered. Good luck. Kathy

I really wish that was the case but it is not. All obesity treatments, surgical and non-surgical including dieticians etc are excluded. I have been going in circles with a UHC account executive and she has confirmed that I was told it was covered but it was an error in their system. They say they have corrected the error and apologized for the 'inconvienience' it has caused. Inconvienience is an understatement. I have sent a plea to my employer asking them to add obesity treatment to our group plan and they are currently reviewing the 'need' for obesity treatment in our establishment.

I am sorry that I haven't got any advice or help for you. I, myself am getting ready to submit to UHC. I was interested in your statement about UHC being "Baratric Suportive". I am so frightened that I will be denied. I have the policy that it is excluded unless medically neccessary. Can I ask where you have heard that UHC is supportive of bariatric procedures? I am just curious because I have been holding my breath since I stated this journey. Thank you!

Hi Dena, I actually heard it from my UHC account executive, my surgeon's office and a friend of mine that has UHC and had RNY. I think all bariatric surguries are excluded unless deemed medically necessary to prevent just anyone thinking surgery is a quick fix to their weight issues. Like I would not agree someone that may be 20-30lbs over weight without the history of long term severe/morbid obesity should seek out surgery . But that is just my opinion. If you meet the criteria and have a policy that does not exclude treatment for obesity, I would think your chances of success are quite good. Good luck!!! Miriam