Searching the Forums for info on United Health Care???

Color me stoopit, but I canNOT figure out how to search the forums on this site. I'm in Maryland, and have been told by a UHC rep that "there is no provision in (my) company's health care plan for weight loss surgery."

HR has been less than responsive, and I'm ready to write a letter.

I have the text of the Maryland law on WLS.
 
Can anyone who's dealt with UHC give me any advice?

Oh - I'm going for VSG.

Thanks,

Sheri

 Try this.  I'm not the author, but its been handed down many many times.  I would be lost without it.

"How to Search This Site (Or any site)

1) Go to http://www.google.com and click the "Advanced Search" link
2) Enter the words or phrases for which you are searching, e.g., chewable vitamin
3) Decide which OH forum or forums you want to search. Go to the forum(s) and copy the URLs. 
 For example:  
 (Duodenal Switch Forum)  http://www.obesityhelp.com/forums/DS/
 (LapBand Forum) http://www.obesityhelp.com/forums/lapband/
 (RNY Forum)  http://www.obesityhelp.com/forums/rny/
 (Ontario Forum) http://www.obesityhelp.com/forums/ON/
4) Enter the URL(s) in the field labelled, "Search within site or domain".  Separate URLs by a comma.
5) Click the "Advanced Search" button.  You will only see results from the OH forum(s) you specify.

Tips:  
To search the entire OH site (every forum), just enter http://www.obesityhelp.com as the URL

Want to see ALL posts by a person (as opposed to only the Latests posts within the current forum)?
Search for their username and their location (found below their avatar).  If you just specify their username, you will get their posts as well as all posts ABOUT them. (Some people are talked about more than they actually post!)"


Good luck!

THANK YOU SO MUCH!!!

Why on earth doesn't this site have its own Search capability???

Ridiculous!

Sheri

Thanks for the post...I've been wondering how to search a specific forum!!

I have UHC PPO.  I am covered under my husband's policy through the state of Georgia. (He is a teacher).  This year is the first year they have covered WLS. 

UHC does covered WLS.  Sounds like your company did not buy into it..I mean they did not pick up that part of the policy.  I was told through UHC that they cover the RNY and the band.

I guess you will have to appeal the exclusion.

Good luck.

Hi Sheri. I am insured through my husband's United Healthcare policy. However, his employer opted out of any WLS. I have spoken to the insurance company myself several times and there's no budging them. They simply don't cover it because the employer doesn't pay for that type of coverage. We've also spoken with his employer directly and they're not budging either. I'm not giving up the fight just yet. I also still plan to get the RNY as soon as possible to save my life.

I did post a thread on the main boards in frustration last night and received quite a bit of useful information. Thread link -
http://www.obesityhelp.com/forums/rny/4007931/Employer-opted-out-of-WLS-coverage/

A wealth of useful information from Pam T. in same thread -

"If you're going to fight the employer, you can't do it with emotion.  You have to do it with hard facts and statistics. 

WLS pays for itself within 24 months
http://www.bloomberg.com/apps/news?sid=aGo2OYxkUfzE&pid=2060 1124
http://www.ajmc.com/issue/managed-care/2008/2008-09-vol14-n9 /Sep08-3582p589-596

New study shows WLS is safe
http://www.asmbs.org/Newsite07/resources/asmbs_news_study.ht ml

NIH Guidelines for determination of medical necessity of WLS
http://consensus.nih.gov/1991/1991GISurgeryObesity084html.ht m

Some information on states that are working on bariatric legislation to eliminate WLS for state workers - follow the protestors in these cases, they might provide information that could help you fight your employer on this.  Prove that it's a real medically necessary condition
http://www.asmbs.org/news/bariatric_surgery_draws_attention. pdf

Here's an excerpt from a book that talks about how to fight exclusions

If you're really ready to fight.  Use these guys
http://www.obesitylaw.com/

Do a Google Search for "bariatric surgery approval with insurance exclusion" -- do some research and reading.

Rather than a face-to-face conversation with the employer, you need to write a letter formally requesting an override in the insurance inclusion or the purchase of a rider for this "medically necessary surgical procedure for the treatment of serious co-morbidities".  You need to include the research and statistics as to why it's in the employers best interest to cover the surgery.  Eliminate emotional pleas - only include statistics and facts.  Make it a formal request.  Address it to the Benefits Manager or Human Resources Manager - not necessarily the owner of the company.   Use a lawyer if necessary.  No cell phone calls with jokes will follow this type of formal request." 

Thanks again Pam. Best of luck to you in your journey, Sheri.

Thanks so much for the info and great links, Pam!!

I live in Maryland, which has a WLS law, so could probably get my company to agree to a waiver... however, the way I read their policy, UHC does not at this time cover the standalone sleeve gastrectomy procedure - it's covered only with an accompanying malabsorption (bypass) procedure, which I'm utterly uninterested in (my BMI is 35.5).

Still researching, but getting closer to going to Mexicali - I'm not getting any younger - or thinner!!!

Sheri

 

I don't know if this will help you or not. I have UHC and have had them for 2 years. They told my surgeon that RNY was covered. Following my surgeons advice. I called and asked specifically what the exclusions in my policy were( being that UHC has a rep for telling u it is covered and it really is not) UHC told me I had no exclusions in my policy and they asked why i was asking and i told them it was for the RNY and they said there were no surgical exclusions, but there is an exclusion for the management and treatment of obesity. so just make sure you have it in written form taht it is covered  just as a CYA measure.

?? Isn't the RNY a treatment for obesity??  Or is surgery not a treatment??  How bizarre!!  I'll be tackling this next week - we were at a campsite all this past week with (shudder!) no internet access!!  LOL!!

Thanks so much for writing this!