Satan's Insurance Company - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

Danniboi · 03-29-2006, 12:23 PM

I just thought I'd drop my .02 on the insurance industry. I have United Healthcare and they approved my while I was in the office on my first visit. Not bad huh? I have had nothing but pleasant experiences with them to date. That was until today. My wife is so impressed with my results that she now wants to get WLS. My wife met with my surgeon a week ago and confirmed that she would be and excellent canidate (46 BMI, high blood pressure). Ok, so my wife gets the ball rolling by calling United to talk to them about it. United then informed my wife that they don't cover WLS and never have. This was their story and they were sticking to it...my wife explained that they had covered my surgery in January. Can you believe that crap? I know that it's clearly covered in the policy, but they figure if they just tell you no that you'll jjst slink off with your tail between your legs. I hate insurance companies, what a scam.

IpsieDixie · 03-29-2006, 01:48 PM

Dannyboi,

Maybe you spoke to someone who was uninformed, or who was in a pissed-off mood and decided to take it out on you. I think you should call again. Or better yet, have someone from the surgeon's office call.

I'm assuming your wife wants to see the same surgeon who did you, right? Is there a claims specialist at the surgeon's office who would work with her to help her get approved?

My surgeon has an office staff member who is an expert at submitting WLS claims to insurance companies. This woman has been very helpful to me and lots of other patients. Ask if your surgeon has somebody like that.

Good luck, and keep us updated on Mrs. D's progress.

Dixie

LisaBoston · 03-29-2006, 02:07 PM

I had an issue with an insurance company yesterday that was covering some of my expenses for WLS. I put in 2 claim forms in Feb and last week got a small cheque in the mail, but the larger one was not there. So I waited till yesterday to call and inquire about it. They say they never received the claim..hmmmm, they were in the same envelope. I kept copies and went to go send them in. At the post office, I checked my PO BOX, and guess what??? The other cheque was there! Hmmm....its true, it all depends on WHO you talk to, even with the so called updated computer systems!

Brooke220 · 03-29-2006, 05:55 PM

I think you spoke to someone who didn't know what they were talking about. I'm basing this on experience. The answers I got depended on who I spoke to at Cigna.

Dave · 03-30-2006, 06:33 AM

My mom called her insurance company and was told they cover them. She submitted official paper work and was sent a letter saying they don't cover them. She then called them up and argued with the lady for a while before getting transfered to someone else. They finally let her talk to a higer up person who said they do cover them but you have to do the 6 month diet and some other crap. They were hoping that she would give up when told no but she didn't.

Baron Patrick · 03-30-2006, 07:46 AM

Who you talk to is what I found to be the key.

Satan's Insurance Company loves to mess with you every way possible. If you don't get the answer you know is right, call back and talk to someone else, or insist on speaking with someone higher up on the ladder.

The point is, don't call once and take the word of whoever is at the other end of the line, whether they say yes or not if your covered. Insurance companies have different plans for different employers, it's all based on what the entity you work for is willing to pay when they "negotiate" the package.

That's what happened to me. The first time I called, they said no. Then I realized my question was to broad (I asked if they cover wls, not a specific procedure.) I called back, and asked if they cover gastric bypass, they said yes (albeit very reluctantly - like they didn't want me to know), but only the LapBand - and blah, blah, blah with their requirements. I called back a third time just to make sure I got the same answer.

Now, I'm "going thru the hoops", doing the six month diet thing with weight watchers. I have the other requirements (BMI over 40, co-morbidities, and most importantly, a doctor who supports me and will fight for me).

Isn't it funny. Insurance companies talk about PREVENTIVE health, but when you ask for a PREVENTIVE procedure, they say no, or make it so damn difficult for you - in hopes you'll give up.

peace and blessings

Velma · 03-30-2006, 03:41 PM

Quote:

Originally Posted by Danniboi

I just thought I'd drop my .02 on the insurance industry. I have United Healthcare and they approved my while I was in the office on my first visit. Not bad huh? I have had nothing but pleasant experiences with them to date. That was until today. My wife is so impressed with my results that she now wants to get WLS. My wife met with my surgeon a week ago and confirmed that she would be and excellent canidate (46 BMI, high blood pressure). Ok, so my wife gets the ball rolling by calling United to talk to them about it. United then informed my wife that they don't cover WLS and never have. This was their story and they were sticking to it...my wife explained that they had covered my surgery in January. Can you believe that crap? I know that it's clearly covered in the policy, but they figure if they just tell you no that you'll jjst slink off with your tail between your legs. I hate insurance companies, what a scam.

Thats funny. My husband is covered under United Healthcare and Im covered as a spouse. I had no problems whatsoever. Smooth sailing. I too was approved that same day. I would have your wife talk to someone else.

karenwd · 03-31-2006, 09:44 PM

Danni, did she call it weight loss surgery or gastric bypass? The wrong person at the insurance company could not know that weight loss surgery is technically gastric bypass surgery. Get the person that handles the insurance for the surgeon's office to check on it. They will have the appropriate medical code for that procedure. I think she just talked with someone inexperienced. Keep trying and good luck to your wife! I have heard of a lot of married couples having the surgery. Awesome!

fatnomore67 · 04-01-2006, 08:11 PM

See what the surgeon or your PCP office can do. I have BC/BS HMO and never once talked to the insurance company. I was approved in hours for a consultation and in 1 day after the consultation.
It was to there benefit, I no longer have sleep apnea, and can move alot better. Knees are getting better, less pain. Except for the $20k gallbladder surgery I just had, they are beginning to save money on me.

Matthew
416/252/199
Open RNY 5-11-05

AngelsKisses · 04-02-2006, 07:52 PM

Oh my gosh I feel you! I have United Health Care as well... I have had quite a few bumps in the road! They have given me the run around about finding a doctor who does WLS saying that they don't have a list of doctors that do those types of operations! My PCP reffered me to a doctor that wasn't covered by UHC. Then they gave me a huge run around finding someone to do my phyc eval! Luckily for me the doctor that I found through you wonderful people has an awesome person that does his insurance stuff! Her name is Chenelle and she has made everything painless! She even called and found me 2 doctors to choose from 5 miles from my house to do the phyc eval! She has totally gone above and beyond for me which I am so greatful for! Sorry to ramble... Good Luck to you and your wife! I would just keep calling back or have the doctor's insurance person handle it!