nervous wreck!

**gracie m** · 02-26-2011 09:44 PM

Here's one I haven't seen posted anywhere..
Has anyone been told by their doctor's office that the gastric sleeve surgery is covered under your medical insurance and then told by the insurance company that it is not? Is it possible that the doctor's office codes it a certain way to assure approval?

**tinarnbsnmph** · 02-28-2011 10:24 AM

Yes, this happened to me. I have United Healthcare insurance and was told by my doctors office that the sleeve was covered. After they submitted the paperwork we were told that it was not covered. However, the insurance company lady ended up asking a nurse that works for the insurance company and found out it was covered it was just the way it was coded was why they said it wasn't covered or the way it was worded I can't remember which. Make sure and have your doctors office double check because if mine hadn't I wouldn't have been able to get the surgery. They wanted me to consider the bypass which i did not want.

**MediaHound** · 02-28-2011 10:30 AM

I would call back and ask someone else, pretend/erase from your memory that they ever told you that..

**Mari** · 03-02-2011 07:44 PM

I have United Health care and I am so nervous abt the approval

**Mostspicy** · 03-02-2011 10:34 PM

I have United Healthcare and was sleeved 3 weeks ago

They should check the codes.

**ukusagirl** · 03-10-2011 05:51 PM

I have uhc as well but I think they only pay 50% right?

**kitsonk** · 03-11-2011 12:27 AM

Having done quite a bit of work for health insurance companies in the States before moving to the UK (including UHC), I can tell you it all depends on the contract your employer has with the insurer.

As others have said, it could be the coding, but in a lot of cases there are limits and exclusions that your employer may or may not be actively aware of. Basically there is a large database where you stick the codes into and it spits out what can and cannot be paid and what group and personal limits have been reached.

There are huge markets in "middle men" who will go around and sell particular insurers and everyone moulds and manipulates the plans into the cost profile that the employer would like to see.

So it is no good saying "well, I though UHC covered X" because I guarantee there are thousands upon thousands of variations of what is and is not covered with each plan. Back in 2001/2002 I was on the edge of a project that was trying to make sure what had been sold matched what was in the database. It was a nightmare.

Your best bet is to talk to your plan owner and find out what the "truth is" and if they think you should be covered then badger the insurer. Because a lot of it is more will than fact.