Question:
Halfway through the approval process my insurance has changed
I will be switching from Aetna HMO to United Healthcare. I've completed much of the process but have not been approved. Has this happened to anyone else? Is United Healthcare easy to deal with in terms of this sort of transition. Many of the required test and appointments have been completed. — tanihe76 (posted on December 11, 2006)
December 11, 2006
United Health care will not cover the surgery. You will have to fight with
them more then likely you will have to for external appeal. Your 1st and
2nd level will be upheld. You may get it overturned on the external appeal.
Sorry to give you bad news.
— Kjackson2
December 11, 2006
I don't know how United Health is but I wanted to pipe in, UH may cover
depending upon your employer and what they selected to include or omit....
good luck.
— Kriola
December 11, 2006
You may find that UH will deny your request based on the "pre-existing
condition clause" If you look in the books "The Doctor's Guide
to Weight Loss Surgery" (chapter 16 Paying for WLS) by Louis
Flancbaum, MD [ISBN: 0-553-38246-2] & "Gastric Bypass
Surgery" by Mary P McGowan, MD (appendix A&B) [ISBN:
0-07-143192-6] you will find some useful information. You can buy these at
any bookstore or go to your library and check them out. Hope this helps...
— Kari_K
December 11, 2006
Samething happen to me. My husband's insurance was through BCBS. When I
was finsh with all my testing I just had to set up appointment with my
Doctor to set up a date for surgery, my husband change employer. My
husband's new employer would not insure us for one month. My husband
purchase Cobra through his previous employer for me for one month so I
would not have lapse of insurance. Thats important because in NC if you
have lapse of insurance, the new carrier wont cover pre-existing
conditions. If you dont have a lapse of coverage, then the new carrier
will not consider it as a pre-exisitng condition. Once my insurance with
Humana was put in force, my doctors office file the claim and they approve
the surgery. You just need to find out if your new insurance plan covers
weightloss surgery. I hope everything goes good. Patricia
— barfiep01
December 11, 2006
Where I work, we have 3 options of the insurance we want to go with. I
have stayed with BCBS of IL due to the fact they at the time I began the
process, were the only one of the 3 that would approve WLS. BCBS of IL had
requirements that took me a year to meet. Beginning 2006 United Healthcare
replaced one of the three insurances. A friend of mine from work, chose
Unitled Healthcare. In Oct. she called to see if they would cover WLS.
They only requirment they had was a letter from her PCP. The bariatric
clinic that we are going through had more requirments for her than did
United Healthcare!!
I agree with one of the previous posts, it depends on your employer.
Best of luck.
— MJP0520
December 11, 2006
A friend of mine has UHC and she was denied the first time due to the fact
that she had not completed a 6-month supervised (i.e. Weight Watchers) diet
plan. The day her 6-months was up, her paperwork was resubmitted to UHC
and she received approval the very next day! She's having surgery on Dec.
19th.
— pbeane1
December 11, 2006
It depends on the plan you will have with United Healthcare. Years ago I
had a plan that denied it but last I had a plan through a different
employer that did cover it. We paid the cobra to keep that UHC plan so
that I could have the surgery because our insurance was changing to Aetna
and then are much harder to deal with in the process to have RNY approved.
Good luck!!
— AnneRie
December 12, 2006
I have UHC PPO and was approved on my first letter. I believe that if you
document your need well in your first letter, stressing your co-morbidities
and have your follow-up letters from your doctors that you can be approved.
Of course, as with everything, it will be on a case by case basis. Make
sure that you cover all bases. Good luck! BJ
— B J.
December 12, 2006
Hi! I am having surgery (RNY) tomorrow. I have United Healthcare
Insurance. They approved me fast!!!! My doctor told me that United
Healthcare was one of the best companies to have if you want this surgery.
I have been very happy with my insurance. But, mine will be changing in
Jan. to Anthem BCBS. I am not sure how they are about the surgery. Good
luck!!! Ronda
— Ronda C.
December 13, 2006
i had my surgery on Sept 27, 2006. I had to have it before Oct 2006
because United Healthcare was changing some of the policies. I was told by
my WLS surgeon that United Healthcare is again allowing the surgery. I
called the customer service rep before I started the process and they gave
me all the details. I suggest you call them and find out what they say.
My copay after all testing, surgery, post op appts, etc is under $2,000. I
am paying $78 a month to pay United Healthcare off. Best advice call your
insurance company and speak to one of the reps, the have your answer.
I was approved after first letter.
— bubblegumgirl
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