Hello!!

I have been doing some reasearch and was wondering if anyone had any luck with United Healthcare Insurance. I also would like some information on how to go about seeing if I am a covered candidate for VSG.

Thanks,

Margoboo

Hello!!

I have been doing some reasearch and was wondering if anyone had any luck with United Healthcare Insurance. I also would like some information on how to go about seeing if I am a covered candidate for VSG.

Thanks,

Margoboo

I have UHC; however it specifically stated in my policy under Exclusions that all WLS is excluded. I even called them and they confirmed that my company's policy had a WLS exclusion. Based on that, I became a self-pay and went to Mexicali and Dr. Acves performed my surgery.

Knowing what I know now, I would have gone to Dr. Aceves even if my insurance did cover WLS - in my opinion, he's the best there is.

I have UHC and WLS was covered. However, they wanted me to do 6 months supervised diet before we could even submit and then they rarely cover the sleeve, so it would be 6-9 months before we even had an answer. Since my part of the costs would be around $6k, I decided to just go to MX and get it done now for $8750.

UHC used to be great. I have some friend who all work at the same place and they all got a sleeve with no hassles and no 6 month supervised diet. Then, UHC had some personnel changes and now no one is getting a sleeve at that company!

One of the newer folks who was denied got Obesity Law on her side and they found out that UHC had done all sorts of things wrong in her case, too. So I think she'll get her sleeve in the end. But she's been fighting for MONTHS now.

It's kind of sad. Especially since my company changed their insurance companies all around and now I have UHC too. :thumbup: But we have a weight loss exclusion and our insurance is self-funded, so it doesn't matter what insurance company we have in a way. They are all just administrators of our contract.

still waiting on approval from UHC... I will let you know what I find out. I believe bariatric surgery is covered with a 20% co-pay for state employees.

Hey there guys I work in the appeals department of UnitedHealthcare but previous to this I worked in Care Coordination and my job was to review obesity surgeries and the policies of the people requesting surgery. Alot of plans have the exclusion including UnitedHealthcare for their own employees. I have wanted this surgery for years but had no option but self pay and I was just about to go that route. I had hoped every year that uhc would change their policy for their employees. Anyway my husband got a job with a company that allows for coverage for their members. So yay me but if anyone has questions about specific policies and if and how this surgery is covered let me know I would be happy to help. I was always happy for the people I got to approve. I loved that part of my job the denials always made me sad.

Michelle

I have UHC. I went through a six month supervised program before anything could be submitted. Then I was told that I might have to appeal, but woo hoo I didn't. Got approved the first time around.

Hi there! My surgeons office will submit next week or two for my surgery,I am SOOO very afraid I will get denied, my husband works for Clopay Garage Doors, Russia Ohio. I have JUMPED thru all the hoops for the past 6 months. I really am stressed about this. Any advice would be GREAT. Thanks much. Vicki

I was covered last Dec by UHC. no six month diet, was approved in about a week.

UHC EPO here. If I would have done everything my nurse case manager @ UHC said to do to begin with I would have been approved along time ago but I listened to my surgeons office instead (you would think they know what they are doing) and it took me almost a year to get approved. After I submitted everything UHC requested it took another week to find out surgeons office needed to open a case for me. I called them to do it and then I was approved the next day. Stay on top of everyone during the whole process and make your surgeons office listen to what the Insurance Company wants.

UHC EPO here. If I would have done everything my nurse case manager @ UHC said to do to begin with I would have been approved along time ago but I listened to my surgeons office instead (you would think they know what they are doing) and it took me almost a year to get approved. After I submitted everything UHC requested it took another week to find out surgeons office needed to open a case for me. I called them to do it and then I was approved the next day. Stay on top of everyone during the whole process and make your surgeons office listen to what the Insurance Company wants.

I didn't pay much attention to the insurance info given to me by my surgeon's office. I figured out at the patient seminar that some of the info they gave differed from what I had been told by the nurse case manager. From then on, I only followed the guidelines of the insurance company. I did have to do the six month supervised diet, psych eval and 6 months of counseling. But once that was all verified, I was approved in about a week. UHC gives some of the quickest approvals from what I've been reading on the message boards.

I have UHC, I called in Apr. of this year, to get things going. My specific plan covers WLS, including the band, the RNY or the sleeve (actually that was the first time I had even heard of the sleeve, from my baratric case manager).

However, we have a High-Deductible plan (first year and my husband's employer gave no other choice, it was HD or nothing) so we first have to hit $5,500 out of "pocket" (basically the pocket is a Health Savings Account, different than an FSA, because you get to keep what you put in there from year to year) and then UHC will pay 90% of whatever is left over in medical bills. So we'll see.

I'm hoping to have everything done and submitted by Oct. 6th at the latest, then of course I'll be waiting to see if I'm APPROVED or DENIED. Hoping to be approved, of course!

I have UHC and was approved in 2 days. I did not have to do a supervised diet and was on the surgery schedule a few weeks after approval. I'm about 5 weeks post op and UHC has already paid 90% of the costs. Good luck to everyone who is waiting for approval!! Once you receive approval everything starts falling into place very quickly!

I'm covered by UHC through my husbands employer. Per our policy WLS is covered. WLS coverage depends if your company purchases the WLS coverage. EPO. ***....We have the *** coverage. So far I have no complaints. All three are covered. I have decided on the sleeve. I have to do 6 months of supervised diet, pysch eval. and labs. So far so good. My surgeon's insurance billing office tells me that they have no problems getting UHC members approved. The case worker with UHC was very helpful. I call her when I have a question and she will answer it or get me an answer before end of day. Work with your insurance provider. I will let everyone know how it goes.

I have UHC, and they require a psych eval, 6 month diet, and 5 years of weight history. I have just submitted my paperwork, and my fingers are crossed!! The person who coordinates insurance info for patients says that they are typically pretty good. She says that they are required to reply within 3 weeks, so I'll let you know what I find out. I'm glad to hear there are good self-pay options in Mexico, if this doesn't work out, however...

I have UHC. I went through a six month supervised program before anything could be submitted. Then I was told that I might have to appeal, but woo hoo I didn't. Got approved the first time around.

spaz,

I have UHC- empire plan. i went to a wls surgeon prepared with 6 month notes of weigh ins and diet attempts from my primary care dr. the patient coordinator told me that the notes would not get me approved. This was perplexing as the notes indicate my health problems. By the way, I have done 1 year of weigh ins. I am very frustrated bc this patient coordinator explained that I would have to do 6 month weigh ins all over!