New and ANNOYED

[sailorbrees 69]

I live in Atlanta and had United Healthcare for years. The deductible was 5000 for the surgery not including psych tests and Bariatric classes. My surgeon in TJ, MX is 4500. I'd be stupid to not go to Mexico. I'm going through A Lighter Me, but there are TONS of options out there. Good luck!

[Geminidrive 389]

According to UHC's website, you qualify: (updated 12/1/2013)

Bariatric surgery, as a primary treatment for weight loss is proven for the following:

1. Class III obesity (BMI > 40 kg/m2)

2. Class II obesity (BMI 35-39.9 kg/m2) in the presence of one or more of the following co-

morbidities:

 Type 2 diabetes

 Cardiovascular disease (e.g., stroke, myocardial infarction, stable or unstable angina

pectoris, hypertension or coronary artery bypass)

 Life-threatening cardiopulmonary problems (e.g., severe sleep apnea, Pickwickian

syndrome, obesity-related cardiomyopathy)

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Bariatric_Surgery.pdf

[Jessiegurl2686 104]

According to UHC's website' date=' you qualify: (updated 12/1/2013)

Bariatric surgery, as a primary treatment for weight loss is proven for the following:

1. Class III obesity (BMI > 40 kg/m2)

2. Class II obesity (BMI 35-39.9 kg/m2) in the presence of one or more of the following co-

morbidities:

 Type 2 diabetes

 Cardiovascular disease (e.g., stroke, myocardial infarction, stable or unstable angina

pectoris, hypertension or coronary artery bypass)

 Life-threatening cardiopulmonary problems (e.g., severe sleep apnea, Pickwickian

syndrome, obesity-related cardiomyopathy)

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Bariatric_Surgery.pdf[/quote']

Thank you for posting that! I told them that's what I saw as well . Uhc said they can send me a copy of MY insurance policy.... Employers can add and edit there policy's ..... So I was told by uhc

[Jessiegurl2686 104]

I live in Atlanta and had United Healthcare for years. The deductible was 5000 for the surgery not including psych tests and Bariatric classes. My surgeon in TJ' date=' MX is 4500. I'd be stupid to not go to Mexico. I'm going through A Lighter Me, but there are TONS of options out there. Good luck![/quote']

My deductible is 1500.....

[ShrinkyDinkMe22 376]

Hope you get it figured out and quickly. I would definitely work with your insurance company and find out what they require. Then maybe look for a new surgeon. The surgeon and coordinator from my understanding would do the appeal. Not a lawyer. But if your surgeon is recommending a lawyer sounds fishy to me.

Good luck!

[SoCalDixieGal 172]

The attny thing sounds fishy. Bet there's a kick back going on.

[CarrieP 50]

All united healthcare policies are written according to what the employer wants and doesn't want to cover. WLS is covered with my policy with a $1000 deductible. I got another phyc appt and its getting submitted to insurance.

Sent from my iPhone using VST

[Beautyandbeyond 227]

I concur ...the atty suggestion sounds a little off base. I would seek out a new surgeon and also use the search tool on this site using the keyword 'appeal' to see what others have done. God speed

[Jessiegurl2686 104]

Thank u! I will look into this more closely

[ashelaine 383]

If your deduct is $1500- will there be any other co-insurance you will owe- I.e- 90/10 or 80/20? Also factor in the company's for all the visits- it adds up quickly. I was incredibly lucky in that my insurance paid 100% and I have only been responsible for my co-pays at the surgeons office.

[luvrkb 34]

I have uhc too. I got my surgery last may and didnt have to do 6 mo diet. However.... My hubby is pursuing now and has to do the 6 mo diet and 2 comorbidities bc his bmi is under 40.

[Jessiegurl2686 104]

If your deduct is 1500- will there be any other co-insurance you will owe- I.e- 90/10 or 80/20? Also factor in the company's for all the visits- it adds up quickly. I was incredibly lucky in that my insurance paid 100% and I have only been responsible for my co-pays at the surgeons office.

I would have to pay 20%.... But the way it's looking this surgrey is out f the question for me... I'm <3 broken

[theshrinkingchef 61]

My surgeon referred me to the attorney.... That's what that office does.... Appeals against weight loss surgreys..... Kelly lindstrom out of California....

Find another surgeon. You shouldn't have to hire an attorney. Call the insurance company to verify their requirements. My insurance required 3 month monitored weight loss, 1 co-morbidity, and a minimum 35 bmi. If you had 40 bmi, you didn't need a co-morbid. The website said I needed 2 co-morbid, but I got approved anyway. My doctor's office did all of the work on my behalf.

If you're going to spend that kind of money, you might as well self pay.

[sara-seeking-sleeve 76]

I would have to pay 20%.... But the way it's looking this surgrey is out f the question for me... I'm <3 broken

When I was getting the crazy run around and kept thinking it was the insurance--- come to find out it was the Medical Group since I have an *** that was really the problem. Have spoken with the insurance, because there is a appeal process? I was almost at the point of getting a lawyer too after my appeal was denied thinking it was all the insurance's fault but I called and spoke with a couple people at the medical group and threatened the lawyer and things suddenly changed. Btw- I have a high BMI, borderline HBP- nothing else.

[Jessiegurl2686 104]

Find another surgeon. You shouldn't have to hire an attorney. Call the insurance company to verify their requirements. My insurance required 3 month monitored weight loss' date=' 1 co-morbidity, and a minimum 35 bmi. If you had 40 bmi, you didn't need a co-morbid. The website said I needed 2 co-morbid, but I got approved anyway. My doctor's office did all of the work on my behalf.

If you're going to spend that kind of money, you might as well self pay.[/quote']

I know what the requirements are Now...called the insurance 6 month diet .... Which I have.... I have medicated diabetes..... I was never told I needed 2 health issues... That's why I was denied . The surgeon office referred me to the same place that u were told .