Question:
UHC OPTION PPO POLICY IS CONFUSING

THE COSTUMER SERVICE REPS OR SO RUDE AND NEITHER HAVE THE SAME ANSWER. CAN ANYONE HELP ME?    — PATRICE T. (posted on August 12, 2003)

August 12, 2003
I have UHC EPO, they paid 100% but I have heard some people's policies have exclusions, what does it say?? When I called they told me it was paid at 100%, you are right some of them are rude and you do always seem to get a different answer, have you tried having your surgeons office talk to them for you? Be sure to write everyones name down that you talk to.
   — Saxbyd

August 12, 2003
It is confusing and I agree that not all CS reps understand that the definition of that is "customer service". Here is the 411: You seemed to have confusion over exclusion - first off, that is a specific difference BY POLICY (meaning every company has the option to exclude if they wish). If your company has NOT excluded, then it is covered and with the EPO policy, that will mean 100%. My friend just had her surgery on July 2 and the bills all came through. UHC EPO paid 100% - there was an $11.00 charge that was some little thing that was not covered but EVERYTHING ELSE was paid 100%. If you have the PPO, then it is covered at 90% UNLESS you've already met your out-of-pocket max for the year (this is YOU, specifically) - if that is the case, then they cover at 100% after that. You didn't really say which option you have but don't worry - you will not pay a lot. I've got the PPO and had not met any of my deductibles - my surgery will cost me $875. If you want more info, email me, please. :)
   — Donya P.

August 12, 2003
Ask to talk to a customer service supervisor since you are not getting the help you need. Also dig through your booklet and find in the exclusions section where it addresses weight loss programs etc. That is where the exclusion will come from, if it is there. Beware as many policies exclude treatment for obesity, which does not apply to us as we are at least MO and possibly SMO. So unless it says it excludes WLS in all cases go for it. <p>The only thing the previous posters didn't mention is that all of their scenarios are based on you using an in-network surgeon and hospital. If not, your portion could be considerably higher. Good Luck! Chris
   — zoedogcbr

August 12, 2003
Well personally United HealthCare is OFF my Christmas list. Jerks denied my tummy tuck with massive hernia AND my breast reduction. I am 24 and they hang to my waist, seriously. They said it was borderline medically necessary. I hear now they have a written exclusion against reconstructive surgery...although I just had a friend get weight loss surgery approved. Go figure.
   — Paula Prichard