jtickle

A benefit exclusion means the insurance company will not pay for it. Appealing won't even do any good because the sleeve is an excluded benefit.

I had a similar situation. My doctor was telling me I needed a 6 diet and of course I argued with them about it. I finally got my requirements in writing, sure enough no diet or psych evaluation. Just have to go to a bariatric center of excellence, be over 18, and bmi over 40. My info goes to insurance sometime this week. I started everything on March 3rd. I am excited but worried I am going to be denied. I guess these are normal feelings.

I honestly think I was put on this earth to bug doctor's offices and insurance companies...lol. When I was going to have back surgery in February, I called UHC so much that they put a rush on my case. It was approved the next day after the supposed rush was put on it. They where even nice to call me and tell me I had been approved. I also have the number to their clinical specialist department, I don't know if this is the department that makes the decisions or not, but they where always able to give me more info about my case, then people could if I called the number on the back of the card.

I called to check if my chart was still in medical review. I passed medical review and my packet was sent to the insurance company. I hope the insurance company doesn't take forever. I have UHC Choice Plus. I am excited, but scared that I am going to be denied.

I am so furious!! I was told that my packet was sent to insurance last week. The insurance coordinator was not even in the office last week. Now why couldn't of they just told me that? I am not going to get attitude with them I would of waited patiently for for my info to be sent off. I called this morning and basically got chewed out by a receptionist. They told me, I would receive a phone call when they heard back from insurance. Well, I want to know when they send it to the insurance company so I call and get updates from them.

Usually when an insurance company excludes something for example, the sleeve there is no way of getting around the exclusion. You could always call the insurance company to get the exact requirements and exclusions.

I had the same problem with the insurance coordinator not believing that I did not need a 6 month diet. I finally had to get my requirements in writing from the insurance company to prove to them that I didn't have to do the 6 months. I started all this on March 3rd and my info is being sent to insurance on Monday. Hopefully they give an approval in a decent amount of time.

Your insurance will pay 80% after you meet your 1000 deductible. I am not sure if that 1000 is applied to your out of pocket. I have UHC Choice Plus and my deductible was met before anything was applied to my out of pocket. Your insurance person at the surgeon's office can explain it better than I can. Feel lucky that your out of pocket is only 2000 mine is 6000. They will probably be able to tell you what you will have to pay.

I have UHC and I didn't have anything like a 6 month diet or counseling thru optum. I hope my approval goes as smoothly as the process getting to this point. Hoping for a mid May surgery.

I don't know anything about dumping syndrome, yet. I have not had my surgery. However, my surgeon wouldn't even let me consider the sleeve because I have reflux so bad. He said the sleeve has a history of causing reflux in patients. So it's RNY for me. Cannot wait to be rid of this stinkin heartburn. Good luck with your WLS journey!

It's not anything unusual. I have had many surgeries. I have always had to pay something to the doctor's office and the hospital. This time I shouldn't have to pay anything for my surgery, because my deductible and out of pocket have been met. I hope you get everything worked out and you have a safe surgery and good recovery.

I am so ready for this. Can't wait to be off some of my meds and to be rid of my horrible heartburn. Being thinner is just going to be a bonus.

I too, am expecting an early June surgery. My chart is in medical review at the surgeon's office right now and they said it could take two to three weeks to get thru this stage. Then it's off to insurance, which I am sure they will take their sweet time. Actually, I don't know if they will be slow or not. I have UHC Choice Plus. I had a back surgery in February it took them 3 weeks to approve it, but it kind of special circumstance. It was for a spinal cord stimulator which has to have a trial and a couple of approvals. UHC doesn't require hardly anything on my part just a bariatric center of excellence, be over 18, and bmi over 40. No diet or psych evaluation. I am already on their preop diet of replacing two meals with protein shakes and a light dinner. I have been on it since March 10th. I have lost 13 pounds just doing their diet. I hope everyone who has a date set has a good surgery and recovery. Also keep us posted. I will be busy playing the waiting game.

I have UHC Choice Plus. I am not required to do a 6 month wait or psych eval. Right now I am just waiting for my chart to be reviewed at the surgeons off then my stuff is off to the insurance company.

Try GNC Pro Performance naturally unflavored. I can't do anything where I can taste the protein in it.

I had my EGD today. The doctor said that even though I have terrible reflux that no damage has been done to my esophagus. I was really worried about that. I have my last appointment with my surgeon's APN and the dietitian on Friday. I hope they get my case sent to the insurance company quickly. The anticipation is killing me.

I have UHC Choice Plus and I am not require to do a 6 month diet. My requirements are be over 18, bariatric center of excellence, bmi over 35 with comorbidities, or bmi over 40. They also do not require a psych evaluation, but the surgeon's office requires one. Your plan requirements are decided by your employer. The best thing to do is get your insurance company to put your requirements in writing.

It depends on your employer, if your plan covers bariatric surgery. I have UHC Choice Plus too. I am not required to have a 6 month diet. They also do not require a psych evaluation but the surgeons office does. Plus I don't have to do the nurse counseling for six months through optum like most UHC customers. I just had to call and enroll in the bariatric resources services through optum.

My last appointment with the bariatric medical specialist and dietitian at my surgeon's office on Friday, April 4. I am feeling very anxious about everything because I am afraid I will not get approved. I have several comorbidities: diabetes, sleep apnea, high cholesterol, high triglycerides, GERD, and a bmi of 46. Should I be this worried?

I am preop and having a real hard time with the Protein shakes. I find they taste like flavored dog food. They have a Vitamin flavor to them, which makes me sick. I have tried mixing them with both Water or milk. In fact, I had Syntrax twist cherry mixed with cold water the other morning and I threw it up. However, I have an issue. I have to purchase Meal Replacement shakes for after surgery from the doctors office. They give a choice of Bariatric Advantage, Celebrate, and unjury. Can anyone recommend any good flavors to me besides chocolate and vanilla? I also have the option of getting unjury unflavored. The only flavored Protein shake I like so far has been syntrax strawberry mousse. I started my preop diet on Monday and have already lost 7 pounds. I don't see the doctor again until April 7th. Jennifer

I don't understand why so many people are shocked by the fact they have to pay the surgeon up front or pay their deductible up front. The surgeon usually has an up front fee. I am have had six surgeries and have always had to pay an fee before surgery. Sometimes they would send it back to me, sometimes they wouldn't. I'm just glad I have met my deductible and out of pocket before my wls. Not trying to be rude, but some of you obviously don't understand how insurance works, give them a call they can explain everything to you.

Since your insurance is new, you may want to make sure you are not under a pre-existing condition clause.

Call the insurance company, sometimes thats the only way to get the ball rolling.

I have UHC. My plan does not require a 6 month diet or a psych evaluation. Like many other people have said in this thread, it depends on what your employer wants to require. I would call UHC and get your requirements in writing because everyone will tell you something different.

I wanted the sleeve too, but i have severe heartburn. I was told by the doctor that sleeve is not a good choice if you have heartburn. I am having an EGD on the 2nd of April and I scared to find out what my esophagus looks like. Gotta feeling it really damaged or i have barrets esophagus.