United Choice Plus

Before scheduling an appt w/ the surgeon, I called United to see if Lap Band was covered under my policy.  The guy told me it wasn't particularly excluded, but required a letter from the doctor, and pre-approval from United.  I may have even called a second time (can't remember, and didn't write it down).  Checked the website (have no writte material from United) and saw no mention of any exclusion.  Met with the surgeon, who was very optomistic on prognosis and approval.  United denied in three business days due to a sudden exclusion.

Tuesday, I hope to hear from one of two people at United that I've contacted (names and numbers provided by my HR department) as to whether it's exlcuded, and to provide me with the written material that it's excluded.  (Without divulging details, the HR rep was incredulous -- "How do you know who is right?" was her comment).

My understanding is if lapband or wls is specifically excluded on the policy then I'm out of luck (high deductible plan where my company pays the first $2k of claims for everyone and then United pays after that) - that I'd have to hope we have a change in coverage at next open enrollement.  Correct?

Anyone have any other thoughts/

Do you know if your company has coverage under their Choice Plus plan with UHC for Roux-en-Y?  I know our Choice Plus plan covers Roux-en-Y and the reason I ask is because if they do cover for Roux-en-Y then would you be willing to consider that over the Lap Band.  Just a thought.  Maybe instead of seeing only why it is that they do not cover the Lap Band see what type of procedure they will cover.

Tammy

Well, I have UHC choice plus also through my hubby's employer, Cracker Barrel.  I do not have an exclusion, but it's really up to your employer whether they exclude it or not.  My policy states that they don't cover obesity related issues "except" for morbid obesity complicated by other serious medical conditions.  Well, I have been denied twice because of no "serious" medical conditions and im on my 2nd appeal.  But, I was just diagnosed with obstructive sleep apnea, so there is no way they can deny me now.  It's a hard fight, but don't give up.  They will give you 1,000 loops to jump through, but eventually they will approve is what ive been told.  Hope everything works out for you!  Manda

I finally spoke with the director of sales in RI as United as no local customer service office.  He was very nice.  Here's what he told me:  United does not cover Lapband on any of it's policies as they are standardly written.  It is only covered when the employer purchases a rider (which mine obviously has no) or when the employer is self funded (which mine is not).  It was unfortunate that the customer service guy who originally told me it was not particularly excluded was WRONG.  He strongly urged me not to appeal as he felt it would be a waste of time.  What I'm hoping is that we switch back to Blue Cross the first of next year (our open enrollment is December).  The United guy told me that BC routinely covers it.

 I am disabled and have a Medicare advantage plan through United Health Care and I am being screwed over so badly I don't know what to do. Not only will they not pay for the surgery I am being told they will not pay for all t he testing I had done.  This ia amounting to thousand of dollars I don't have because I am disabled.  Please get everything in  writing before you go any further and make sure they will pay fo r everything.  I hope you have more luck and success than I did.