This is what the Insurance Benefit person told me today

Unfortunately, under the contract your company has with UHC Lap Band surgery is specifically excluded. All of United Healthcare’s Small Group Choice Plus certificates exclude coverage for this procedure. UHC does have plans available that offer coverage for Lap Band surgery but those are called partially self-funded plans and the employer can sort of pick and choose their benefits. There is no rider available under their contract to add a Lap Band rider. It is simply not available. I understand where you are coming from but unfortunately, it is not your companies decision as to whether the procedure will be covered or not so there is really nothing they can do. The appeals process is the only way to have a claim manually reviewed with all of your documentation by their clinical doctors and medical directors but there is no guarantee it will be approved. In all honesty I am pretty certain it will be denied by United Healthcare due to the fact that the surgery is specifically excluded even when medically necessary.

 

 Does anyone have any suggestions at this point for me? The insurance people sure do make it seem like this is a no win battle!!!!!!!!!!!!!

Do they approve any type of WLS? If you're 100% set on the LapBand, then would high recommend posting this on the lapband forum and seeing if anyone there has had any luck with UHC. 

I wish I could offer encouragement.  I'm hoping to get RNY rather than band, but my employer is singing the same song as yours.  I'm in the process of trying to get them to cover the surgery , but I feel as though I might as well beat my head against a brick wall. The only thing I can suggest is to be persistent. I am trying to do the right things--a letter from my doctor, a bunch of research to show that I know the benefits and risks of WLS, and showing that it can benefit me specifically. Additionally I've been doing the medically supervised weight loss thing: seeing my doctor on a monthly basis and trying hard to lose weight. I have been to human resources, my departmental supervisor, my division supervisor and am currently being asked for more documentation/justification before going to the next step up the ladder.  It's my opinion that this is all a bunch of foot-dragging and delaying in hopes that I'll give up and go away.  They have slowed me down some and discouraged me a whole lot, but I'm not giving up or going away. If you choose to go this route, be aware that it is emotionally draining, depressing and can be devastating to any vestiges of self-esteem you may have. I have had to give myself a bit of "healing" time; an opportunity also to get things into perspective and  re-focus my thoughts. It's an ugly fight, possibly no-win, but I intend to stick with it! Good luck to you!

Hi!   I have 25 years of experience in medical insurance appeals, contracts in the capacity as a Manager.  But now medically retired.  I can tell you right off that because your employer is under a Small Group Choice and that is a specific exclusion and its in black and white,  no appeal panel or insurance comissioner or government agency can overturn that decision.   If its not covered its not covered peroid.   I know it bites but really its not the insurance companies fault its not covered, its because of the type policy your employer chose to be underwritten under.   They probably are not a large employee based company to have a contract under a large group partially self funded contract.    I hate to be the bearer of bad news and I feel your pain and empathize with you totally.

Now, what if I've talked to my HR dept. and they have said that they are on my side 100% and can/will contact UHC and have them override this exclusion?  Is this possible for them to contact the insurance company and have them override this?

That is kinda a grey area/    Since the insurance company said it was not self funded or partial self funded I dont give much hope that with HR calling them and asking them to override the exclusion will happen.   They can try all they can do is tell them no