Empire/United Healthcare NYSHIP

I have just started with my first visit to the Surgeon.  He office coordinator said my insurance is normally good at covering everything yet when I called them (the insurance) they seem to have some crazy policies.   I have to go to a Nut but they won't cover her fee.  When I called about the Psch they told me they don't cover evaluations they only cover if I have a problem.  They are requiring me to make these appointments but they don't cover them??  Does that seem right? 

I am sorry for the issues you are experiencing with your health insurance company. While it is possible that your visit to the nutritionist and the psychiatrist are not covered benefits based on your explanation of coverage, it's not likely.  It's more likely that if your plan covers bariatric surgery, then it will cover everything associated with getting the surgery, including any required testing and medical visits, especially since bariatric surgery is a pre-authorized procedure. I would suggest that you look at your explanation of coverage, which should be the governing document of your plan, to get more information about what your coverage actually is.  If you don't have a copy of it, you should be able to go on your insurance company's Web site to get coverage information (typically under provider information) or call the customer service number to request one mailed or faxed to you. I hope I was able to provide you with information to assist you.

Ive never heard of any insurance covering the nutritionist  and psych. but considering the overall cost of surgery this is minimal especially if you are lucky enough to have coverage for WLS. Good Luck

you need to ask them if they cover the weight loss surgery, my insurance paid for the consultations with psch doctor and nutritionist and then denied me for the surgery saying they dont cover weight loss surgery it is so dissapointing to go through all of this only to find out in the end you cant have the surgery because its not covered.

I want to iterate that you should check with your plan's documents, as those documents will be the governing guideline over whether there is coverage or not.  Customer service representatives, while they have such a difficult job to do at times, make mistakes in quoting benefits.  Reading your benefits coverage in your plan documents is indisputable though. Also, to the poster who stated that she has never heard of any insurance companies covering nutritional and psychological testing in advance of surgeries, there are hundreds of plans with insurance companies that cover it, including mine and most of the plans that I have worked to administer while working with an insurance company.  Ultimately, it depends on what riders a person or company has paid for that will determine coverage. Again, the governing documents are your plan documents.  Check with them to get a better picture of where you stand in terms of total coverage.

Thank you for your suggestions.  I have called the insurance and they do cover the surgery and the pre-op doctor visits but not the Psych or the Nut which seems ridiculous since they require it.

As I said- I never heard of any, didnt say it didnt exist. EVERYONE i know who has had WLS has paid out of pocket for NUT and PSY*****luding myself. Actually as i write this i need to correct myself UHC did cover small portion of PSYCH.  i believe I paid $125 for NUT and $75 for psych. I was denied due to non coverage but as I said earlier $200 out of pocket is nothing compared to the average $25,000 for surgery.

Thanks for your help! My insurance does cover WLS so we shall see if I am approved

I have the Empire NYSHIP plan also. Understand that no insurance covers the services of a nutritionist but that should be subsumed under the cost of your first visit to the surgeon or nurse pracitioner. The psych. eval. is a little trickier. It is certainly a covered expense under our plan but it has to be pre-approved. I'm a clinical psychologist myself so I just had one of my colleagues do mine. But it can certainly be a covered expense. As you are probably aleready aware, our insurance is pretty much the Rolls Royce of the industry. All doctors/hospitals love it. If your surgeon isn't participating, it'll be covered as a "out of network expense." Our plan has a $1650 'stop-loss' clause where any expenses over that in a calender year are covered at 100% after a (I believe) $250 deductible. They do not require a "doctor supervised 6/9/12 month diet," etc....only a brief note from your PCP in addition to the other required tests (usually a sleep apnea study, stress test, echocardiogram, colonoscopy if you're over 50 and a bunch of blood work). My first appt. with the nurse practitioner was 8-16-07 and I had everything done for insurance submission by 9-7-07. I was approved for LapBand surgery on 9-14-07. My appointment with the surgeon is 11-6-07 and I expect the surgery will take place about 2-4 weeks after this. Have no fear, insurance approval is a breeze with our insurance.

I HAVE THE EMPIRE PLAN (NYSHIP) AS WELL. WHEN I MET WITH MY SURGEON LAST WEEK, HIS SECRETARY SWORE TO ME THAT I NEEDED A 6 MONTH HISTORY AS WELL AS A ONE MONTH APPROVAL WAIT BEFORE I CAN GET COVERAGE FOR TE LAP BAND. WHEN I CALLED NYSHIP, THEY NEVER GIVE ME A STRAIGHT ANSWER. IS THERE ANYTHING IN WRITING ON THE NYSHIP WEBSITE WHICH CLEARLY STATE THE CRITERIA. IM CONFUSED ! HELP!