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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!

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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

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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

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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.....

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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!

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

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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

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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

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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.

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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.

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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

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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.

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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.

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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 .

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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.
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