[ageoldie]

We are looking into changing insurance for our company soon, and I want to be sure to go to one that's WLS-friendly. Any suggestions on who to check with? I know not Kiaser!!! But what insurances do the rest of you have and did you have any problems getting approval? One we are considering is UNI-CARE
Any one know anything about it?

[BevMel]

hi barb

i hope everything is still going okay with mom
my ins is united health care
the thing the clinic told me early on is that don't question the ins
yourself that only throws up red flags they find that the bigger
your group is with employer the better the coverage
what they did was found out early if hosp and drs was in my network also out of pocket and deductibles on allowable surgeries
from there they did diag test for core health problems
from memory i had sleep apnaia (not sure how you spell it)
weak bladder, joint pains, shortness of breath, in all i had 5 core
problems the ins looks for
then when i was ready to go to surgery i was let go from my job
so i had a delay in getting cobra and of course that is expensive and with no job but GOD is good i won my unemployment so that
pays for ins but i digress lol
when the submited it to ins it did have to go to review board which the clinic said was unusal for uhc but after first review they
did approve it i had surgery Sept 18 and bills are going to my ins
and GOD is good the only thing they did not approve was my clinic has private suites for their patients and hopefully they will write this off b/c it was on drs orders

the thing to remember is make sure that new ins does not deny for preexisting

[miller205]

Thank you so much!!! I also have United Health Care and have not called to question them about it for the same reason that you stated. No sense giving them advanced warning and time to think of reasons not to cover the surgery. I was wondering if they would in fact ever cover weight loss surgery as it seems that they cover no weight loss medications.
One question: How much did the insurance cover of the after care from the surgery? How often do you have to pay co-pays and what about prescriptions, is the coverage decent there? I realize my plan will be slightly different from yours (I have Select POS) but I work for a very large company so maybe it won't be such an issue. Thanks

[BevMel]

hi

[BevMel]

hi again miller

did not know if i was on post
my ins is also select pos the one where you don't need to be referred to a specialist my prescriptions is thru medco 8, 20, 35 or 50% if only premium can be prescribed

i have been watching my bills and everything was done on network and my deductible had already been met because my husband had 2 surgeries this year this is something to consider the timing of your operation with your deduct if you are close do it this year if not wait till beginning of next year since after your operation your deduct would be met

of course in my case i lost my job and cobra only covers for 18 months bit fortunatly my deduct had been met

the only bill i am not sure of is the lady who put me to sleep
can't spell her title lol i did not think of checking if she is in my network (i am keeping my fingers crossed) if i think of anything else i will post
later
bevmel

[miller205]

Thanks Bevmel!! I don't have a deductible in-network but I do have a similar plan through Medco for prescriptions and that is such a headache trying to figure out what prescriptions will cost. We get my husbands Advair inhalers mail order because it is $35 for a 3 month supply whereas at the pharmacy it would be $75 for one month! Very strange...however, my bloodpressure meds are only $4 a month generic! Go figure. Have you seen the new UHC website where you can price your prescriptions ahead of time? Very informative I plugged in the names of several prescriptions that I knew off hand, they will NOT cover Meridia at all ever, anti depressants are barely covered (Wellbutrin which under another name is prescribed for weight loss), but will cover Zyban which is aliased as...Wellbutrin. I bet if I could figure out the alias for Wellbutrin prescribed as a weight loss aid I would find that it is not covered. Insurance, can't live with it can't live without it.

[jiffypop]

welbutrin = zyban = bupropion. isn't it amazing that they'll cover it for stopping smoking or depression but not cover the same drug for weight loss?????

[BevMel]

hi miller

i think i confused you the out of pocket deduct is not for prescrip
it is for testing hospital stays etc mine was 3000 for family
so since i had met it for year i do not pay for anything my coverage for that sort of thing for in net work fac and doctors was 90/10 since i met out of pocket i don't even have to pay 10%
hope this clears this up
later
bevmel

[BabySteps]

Have you been to "obesityhelp.com" they have a place there that you can look up different insurance co. and Doctors it looks like a very helpful site. I too am thinking about this for myself.