Getting the run around - ThinnerTimes

Vszymczak · 04-28-2008, 12:28 PM

I've been working with a really awesome Doctor's office who has been helping me the most the can. They contacted my insurance company this morning "United Healthcare" to see what is or isn't covered under my insurance. They simply stated they do not cover any weight loss methods including but not limited to surgery. In speaking with this person at the doctor's office this isn't always the case. She instructed me to obtain a copy of my "benefits summery policy". So I contacted my husband's employer's Human resources department and asked for a copy of this. They stated they were all out in the office and that i would have to contact uhc to get a copy of this policy. I also asked her about this and she stated that they purposely excluded this procedure so they wouldn't have to pay higher premiums. I was told this isn't always the truth as well. Human resources departments tell you that to discourage you from having the surgery. So again I contacted United Healthcare requesting a copy of this policy and stating that the Human resources department was out of the policy. United healthcare told me they couldn't provide me with this policy because the employer requested specifically that they not hand out the policy so that the employees would have to go through Human resources. So again *sigh* i contacted the human resources department and got the SAME very rude woman and she stated they were out and she was unable to obtain any more policy forms. Now i think this is crazy that neither my insurance company nor my husband's employer will provide me with a policy. This some how seems illegal or unethical or something i swear! I feel like i'm getting the run around, is there anything that i can do about this and obtain a copy of my policy??

Native2u · 04-28-2008, 12:38 PM

Do they have an online website? I know that Aetna does (my insur) and that is where I got my info from.

If I were you, I'd call and ask if they have a website (don't tell them what its for), just get the web address and go from there.

Vszymczak · 04-28-2008, 12:45 PM

Quote:

Originally Posted by Native2u

Do they have an online website?

They actually do have a website, and I've been on it to see my Policy. However, Under specialty *because i guess this is what the surgery is considered* it just says not applicable. And i was told by UHC themselves that there is almost always fine print on the policy which is why i need to get a hold of the policy because it won't say this on their website.

Native2u · 04-28-2008, 12:51 PM

I would continue asking and calling them. I wouldn't give up. If the person answering the phone is rude, get her name and ask to speak to her supervisor. There has to be a policy on "special Surgeries".

Maybe even ask her supervisor, how is the surgery classified & what it is under.

sasha23 · 04-28-2008, 01:43 PM

i would call either of them back and tell them that by law, they have to provide you with a summary of your benefits. the insurance commission has what they call the patient's bill of rights that state you have the right to know what your policy benefits are. i would try HR at your husband's job first. just let them know in a polite way that you contacted your state insurance commission's office, and were told that they have to provide you with a copy of your benefits. if they don't comply, you will report them to the state. i know that sounds harsh and i know you don't want to tick them off, but you have to do what you have to do to get what you need to get your approval. obviously, they are not very helpful.

that is the first thing my surgeon requires, so this is very important that you have this information.

Vszymczak · 04-28-2008, 06:02 PM

Thanks, I actually considered contacting them tomorrow and putting on my mean mommy face rather than my nice walk all over me face. Hopefully I'll be getting some answers soon!!

Native2u · 04-29-2008, 07:20 AM

Quote:

Originally Posted by Vszymczak

Thanks, I actually considered contacting them tomorrow and putting on my mean mommy face rather than my nice walk all over me face. Hopefully I'll be getting some answers soon!!

I personally think that you should do just this! I would if I were in your position.

Vszymczak · 04-29-2008, 12:47 PM

BLAH! So I got a copy of the policy and I know that this might come as a shock to you but they were actually telling the truth. Under exclusions it states "surgical and non-surgical treatment of obesity (including morbid obesity)." They suck! Anyways I guess there are always other options other than taking out a loan because I'm not really able to do that. My husband is going to check his teacher retirement fund and see if he can borrow against that. My mom just got a large settlement of money and had offered to pay for it at one point in time before she knew it was going to be $23,000. But she said she's still willing to pay just not $23,000. She's going to maybe pay off her 401k and then borrow against that to pay for it at $23,000 if she has to. But I guess that's really a worst case scenario. There are other options as well. I've looked into personal insurance coverage and of course this surgery is specifically excluded. However, and maybe this will sound very terrible, I'm not sure, we have found out that medicare and medicaid will pay for this surgery. And since my husband doesn't make a whole lot of money and I'm a stay at home mom there is a chance that I can get medicare. This might actually involve us filing for a legal separation for a little while which I also don't want to do...Just an idea I suppose. Like my mom told me "it'll all work out the way it's suppose to" < - - - - I hate that phrase by the way

Native2u · 04-29-2008, 02:36 PM

I wouldn't give up!

What about looking into surgery in Mexico? I know that there are people here on TT that have had surgery done in Mexico and we really happy with the Doctor and results.

Just a thought.

Vszymczak · 04-29-2008, 03:38 PM

You know I did consider that. But my husband already doesn't want me to have the surgery. I've been working on losing weight the last couple of weeks and I've already lost a total of 20lbs, and he doesn't like that either. I don't think it has anything to do with liking bigger girls since I was way smaller when we met before I gave birth to his two over sized children. I think it has more to do with the fact that he doesn't want me to be thinner. Like he's insecure that I will leave him for a much cuter richer man. I tried to explain that I'm already gorgeous so it has nothing to do with being insecure. Heck, I'm worried I'm going to lose my awesome breasts *pouts* But I'm doing it to be healthier for my children and because my older brother is worried about me and the complications with being this heavy. He surely wouldn't go for me having the surgery in Mexico because while some of the doctors are certified through the American Board of Bariatrics, the nurses, anesthesiologists and hospitals aren't. He'd never go for it.