Question:
Has anyone had LAP-RNY covered by UHC without paying surgeon?

I have been told by my surgeons office UHC doesn't pay them their LAP fee, so they charge $2000 out of pocket for the procedure, has anyone in Miami had LAP-RNY without paying??    — [Anonymous] (posted on May 31, 2001)

May 31, 2001
I had Aetna usHealthcare, and it states in their web-site, that they do pay for lap surgeries
   — Marie B.

May 31, 2001
I also went through that...I'm w/ UHC PPO in Georgia. I was told I had to pay $3800 + at the last minute. So, I did some research...Asked them if they are a part of UHC"S network. If not , find a Dr. who networks w/ UHC. If/ & when you do, UHC will cover you 100%. If you contact the insurance company, they will give you a list of Doctors that perform this procedure w/in the "NetWork"...Sounds like you have a Dr. who is not a part of the "network".
   — RisQue

May 31, 2001
Your surgeon leads you and others to believe that the insurance company doesnt not cover the Laparascopic part of the procedure... and thus the $2000 fee if you want the operation done laparascopically. This is not true. Your insurance company for a fact covers the surgery done either way. I was approved with that insurance in days for Lap RNY with a different surgeon in south florida. Call Drs. Carrasquilla and English at Florida Hospital. Dr. Carrasquilla has been the chief of surgery at the hospital for years and for a long time was the only doctor doing this procedure laparascopically in Florida. These doctors do all of their surgeries laparascopically and accept what the insurance company gives them. They dont bend the truth and lead their patients to believe they need to come up with $2000 out of pocket to have lap surgery. That is not fair to you. My friend got caught in this '$2000 additional for lap' scam and had to suffer additional pain and recouperation because she didnt have the money. I would never go to your doc because of this.
   — [Anonymous]

May 31, 2001
I too was originally going to the surgeon you are probably referring to. It is always buyer beware. After all of the research I have done, and all the people I have talked to, the extra $2000 for the lap and now the new $600 fee for support groups, etc...well they have also led me to Dr. Carisiquilla (who's name I will learn to spell one day). My first question was "do you charge extra for lap?" and they told me absolutely not. The other office also did not mention that they were not a part of my insurance's network & I was not aware. That means I would have shelled out A LOT of money that I could be using for my new wardrobe!
   — [Anonymous]

May 31, 2001
I haven't had my surgery yet, but my insurance is with UHC and I'm having lap. Lap is covered and you should not have to pay any extra as long as the surgeon is in network. You can check with UHC's website: http://www.uhc.com/providerdirectories/index.html to verify whether your surgeon is in network or not.
   — Lori W.

June 1, 2001
I ended up having an Open RNY on May 1. A week before my surgery my surgeon's office notified me that UHC would not cover LAP. I got on the phone and called member services and got transfered all the way to medical review. As of MAY 1, UHC considers LAP RNY experimental and will not cover the proceedure. Mind you I had been for LAP RNY since January. To protect yourself from a possible refusal of coverage call anonymously and ask member services if they will cover the balance due if you go that route.
   — Valerie J.