Anyone know which UHC plans cover gastric bypass?
I was hoping someone could tell me which specific plans cover the gastric bypass surgery under United Health Care. My employer has asked me to research the topic because our insurance agent is saying no UHC plan covers the surgery. I know this is false because many people have been covered by UHC. If I could go back to my employer and say X,Yand Z plans cover the surgery, I may have a leg to stand on. I am trying to get my employer to change our policies when the renewal is up. UHC is awful to talk to, they leave you on hold for hours and dont have many answers.
Any help would be great!
Jonnalee
Any help would be great!
Jonnalee
It's not something we could answer, because plans are drawn up and offered to employers based on employee size, location, etc.
If your employer has less than 100 employees, it could very well be there are no plans available from UHC. Most insurance companies only offer the bare minimum to small employers. Also, in a few areas of the country where their is lack of protection laws, they will try and get away with offering NO plans that include WLS.
I would call UHC directly and ask them if they offer a rider that includes WLS to employers, and if so, what would the requirements be (# of employees, etc).
If your employer has less than 100 employees, it could very well be there are no plans available from UHC. Most insurance companies only offer the bare minimum to small employers. Also, in a few areas of the country where their is lack of protection laws, they will try and get away with offering NO plans that include WLS.
I would call UHC directly and ask them if they offer a rider that includes WLS to employers, and if so, what would the requirements be (# of employees, etc).
Duodenal Switch hybrid due to complications.
Click! > DS Documents ~ VitaLady.com ~ DSFacts.com ~ OH DS FB
Click! > DS Documents ~ VitaLady.com ~ DSFacts.com ~ OH DS FB
(deactivated member)
on 8/2/08 2:51 pm
on 8/2/08 2:51 pm
I had united ppo last year when I was banded. Prior to getting insurance in 07, none of my companies insurance covered weightloss surgery. In 2007, all cover it. I changed to BCBS this year and I am in the process of getting a failed band removed to sleeve or DS. I am not sure if changing insurance will help me or hurt me. I had no idea I would be getting my band removed this year. I will get some answers from my DR office monday. And will go on from there. I am looking at all my options including selfpay. Even though, I don't want the debt, I do want to get going with my weightloss again.
I wish you the best!
shotgun
I wish you the best!
shotgun
My husband's company has several different types of insurance options for their employees' to chose from. The one that we have with UHC is the Choice Plus plan and according to UHC their only main requirement is that it be a medical necessity. Once their review board approves it then the covereage we have for that is 100% on hospital and surgical procedure (at in-network in-patient stay), 100% for surgeon and all specialists, and 100% on labs and tests (all with no deductible or co-pay). For all other (PCP appointments and check-ups) I have my $15 co-pay. IF anyone is out of network then they will pay 70%, but I would have to notify "Care Coordination" through UHC. For the Psych Eval that is covered with my $15 co-pay but I had to call and get pre-authorization... unless I decided to use one of the ones at St. Vincent's Bariatric Center and just pay their fee out right and then later file the claim with my insurance company.
From what I was told by UHC it depends upon the employer and if they want this to be apart of their individual plans. They (your employer) may have told them they didn't want the coverage on any one of their offered plans. From what I understood from UHC as far as our particular policy goes with my husband's employer the Choice Plus is the best plan and is the only plan they have with the employer where the only requirement / pre-requisite is that it be determined a medical necessity. Other plans require the 40+ BMI, etc., etc. but this one requires only medical necessity. So it may not be that UHC is lying about it not being offered, but it may just be that it is not offered on any health plan that your company has chosen to have under employee policy. From what I have been told from DH and a few he works with about 6 people he works with have had this surgery and didn't have any problems what so ever with UHC and their Choice Plus plans. I really think it depends greatly on the company's policy with them.
I don't know if this helps or not, but I hope it does.
From what I was told by UHC it depends upon the employer and if they want this to be apart of their individual plans. They (your employer) may have told them they didn't want the coverage on any one of their offered plans. From what I understood from UHC as far as our particular policy goes with my husband's employer the Choice Plus is the best plan and is the only plan they have with the employer where the only requirement / pre-requisite is that it be determined a medical necessity. Other plans require the 40+ BMI, etc., etc. but this one requires only medical necessity. So it may not be that UHC is lying about it not being offered, but it may just be that it is not offered on any health plan that your company has chosen to have under employee policy. From what I have been told from DH and a few he works with about 6 people he works with have had this surgery and didn't have any problems what so ever with UHC and their Choice Plus plans. I really think it depends greatly on the company's policy with them.
I don't know if this helps or not, but I hope it does.