Anyone have United Health Care EPO/PPO?

Sweetness · 11-02-2004, 01:09 PM

Just curious if anyone has been able to get approved for coverage with United Health Care PPO using a non-innetwork physician but in network hospital. So far they are saying the hospital is covered under my insurance but the full surgeon bill would NOT be. Leaves about 7,000 to 8,500 for me to pay. But, they said if he is the only surgeon with in 30 mile radius of my house to do this there is a chance i would be covered. ( currently he is the only one with in 25 miles. ) But, not sure if they mean bariatric surgeon or LAP-BAND® surgeon..

Argh... Insurance companies.. such a pain!

Lioness81970 · 11-02-2004, 04:40 PM

I have United EPO - my surgery was covered 100% - I think it has to do with your policy. You have to go through it with a fine tooth comb. Lucky I had a stipulation in mine that stated it was not covered unless it was medically necessary. I dont even bother to call the insurance company cause 99% of the time I call I get a different answer from everyone.

11-13-2004, 02:02 PM

Hello
I would like to get LAP-BAND®, but currently I have Kaiser. I have the chance to sign up for United, but was wondering what their requirements were for LAP-BAND®. I think I can do network or nonnetwork....Anyone have any ideas. The information I was given doesnt have anymore information
Thanks

Sweetness · 11-13-2004, 05:28 PM

Hello,

As far as i know, my best friend has Kaiser and had to go through a year of monitored diets, then has to go through another 8months of group meetings/and loosing 10% of her body weight before Kaiser will do her surgury. (and she's having gastric bypass)
As Far as United, I changed to PPO because i can use an out of network doctor. But, you company will have policies if their plans cover the procedure....You can probably call and ask. Mine does cover it, but a 'exception' or 'case study' had to be opened.... and a BAZIOLLION tests had to be done.. but im ok with those! :)

HOpe that helps...

CandyB · 11-16-2004, 05:40 PM

I have UHC PPO. My surgeon was out of network. My hospital was in network. My anesthesiologist and radiologist were also in network.(You need to check with these doctors before your surgery, but if your hospital is in network, your anesthesiologist and radiologist are most likely willing to accept what UHC pays). Since WLS for morbid obesity is an approved procedure in the policy purchased by our workplace, my surgery was covered. Hospital and in network doctors 100%. Surgeon 70% after meeting my deductible. The balance owed to the surgeon I negotiated with him. I was lucky. He accepted the difference between what the insurance company paid him (about $4,500) and what he "needed" to receive for the surgery ($6,000). I paid him $1,500. But I was fortunate. His office usually asks for $2,500 up front for out-of-network patients. He made an exception for me, and I'm very grateful. I am not a woman of means.

New Hope · 11-16-2004, 05:49 PM

Please be sure you have all of the answers in writing from your insurance company before you get your band. Avoid any unpleasant $$$ surprises! Best of luck to you!

Sweetness · 11-16-2004, 05:53 PM

Candy, This sounds almost exactly like what I am going through with UHC. Glad to see there is hope! I will definitly get things in writing.. good idea new hope.. and my surgeon also said that they were willing to negotiate price etc. Still have to wait for PPO to take effect.. about month and half yayaya..
having last of tests these next two weeks.. sleep study, and psych exam how fun :)

New Hope · 11-16-2004, 05:58 PM

Check when your insurance policy renews. Our UHC PPO renews 1/1/2005. See if any changes will be taking place that can affect you...like change in drs., hospitals, amounts covered, type surgery covered, co-pays, deductibles, etc.

leatha_g · 11-17-2004, 11:21 PM

My insurance changes to UHC on Jan 1. Cigna paid for my band and rebanding and fills. I sure hope this all carries over.