changing insurance plans after banding

[katy517]

I was banded this year under a plan that will no longer be available to me as of Jan. 2011 so I'll be opting back into my employer's medical coverage. I have two options under that plan - United Health Care PPO or UHC EPO. From what I understand both specifically exclude WLS, but I've read conflicting information concerning what UHC covers on the various WLS forums.

I've confirmed that my LAP-BAND® surgeon is not included in either network. Am wondering whether post-surgical fills or follow-up visits will be included? They're not WLS, but definitely related. There is no preexisting condition clause so that's not an issue. What I'm especially unclear on is whether the WLS exclusion would also exclude related post-op care. It looks like I should choose the PPO option if I want any portion of visits with my LAP-BAND® surgeon to be covered at all.

Also have an ongoing issue with my port and might be in need of a follow-up surgery to correct the problem. thing we can do to truly resolve it is another surgery. Am now concerned that I need to do that sooner than later if it would be considered WLS to be sure it's covered or if it would even be categorized as WLS since it's corrective. Am wondering too whether that surgery should be covered by the surgeon since it's a problem arising from the original banding.

Thanks.
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[MommaStone]

I'd suggest contacting one of your employer's benefit reps and ask him/her to track down the questions related to the coverage of the plans. Sounds like getting the surgery before the switch might be a good idea, even though corrective, I'm guessing it would be coded as WLS

[katy517]

Thanks. I did that early on and unfortunately got very little info other than the plans both specifically exclude WLS. There's zero information concerning related procedures in the written docs that I've been provided with and they tell me that both represent the entire plan documents.

Was hoping that perhaps others have gone through similar experiences with related procedures and/or surgery to correct WLS problems and who covers such matters.
I'd suggest contacting one of your employer's benefit reps and ask him/her to track down the questions related to the coverage of the plans. Sounds like getting the surgery before the switch might be a good idea, even though corrective, I'm guessing it would be coded as WLS

[fatcat]

I have UHC. It did not cover any part of the pre-surgery visits, medical tests or the surgery itself. However, I did have a problem a couple of weeks ago and needed to go to the hospitsl for a barium swallow to see if everything was okay. UHC did cover that.

[katy517]

Thanks. That's just the type of feedback I'm looking for. Are you in a PPO-type plan?
I have UHC. It did not cover any part of the pre-surgery visits, medical tests or the surgery itself. However, I did have a problem a couple of weeks ago and needed to go to the hospitsl for a barium swallow to see if everything was okay. UHC did cover that.