So super discouraged I was denied by my insurance even though my bmi 52!!! Anyone with UHC what is your plan??

Unfortunately I don't work for them anymore but I couldn't tell you why plans cover wls. All we serviced was small groups, which mean 1- 50 employees. And none of the ones we serviced covered wls. Our managers made sure to tell us that over and over. I used to feel so bad when someone would call and I had to tell them it was not covered and would not be under any circumstances.

I have UHC too with at&t as my employer. UHC sucks. They declined me 3 years ago because I couldn't prove 5 years of Morbid Obesity. I'm one of those 55 BMI=er's that never went to the doc, so I don't have a recorded weight for 5 consecutive years. Fast forward 3 years later and 60 lbs heavier, they finally approved me. This time I sent them multiple letters from myself and family. I also included photos with my shirt off so they could get a realistic idea of me. I also included photos of the scale. I'm 2 weeks out and feeling great. Down almost 30 lbs since my initial visit. As many said, keep trying.

I would like to add my two cents as I work for a company that provides prescription benefits to employers for their employees. First my company, just like UHC offers "your" employer various plans, some of which may or may not have WLS benefits, (my employer different coverage for different medications). Companies such as AT&T are self insured which means they choose an insurance company offering the best administative price for an insurance package they have selected. UHC offered various packages to AT&T who in turn selects what type of plan they want to offer their employees, the plan that they will pay for the WLS or the plan that doesn't. (One will cost more then other won't). Thus, UHC doesn't make the decision whether you can have WLS your employer did. UHC then administers AT&T's account and they have to abide by the rules of the plan selected by your employer. Now if you want to blame UHC then blame them for offering the "no WLS benefit package plan" and then you can blame the next insurance company for the same exclusion because your employer will change to an insurance company that does have that exclusion as it probably will be cheater. So who made the decision regarding WLS it was your EMPLOYER, obvious they don't care if you end up in the hospital with a major stroke, ambutation because of diabetes, or a major heart attack even though it will be costing them (remember they are self insured they foot what you don't have to pay the doctors, labs, and hospital). Insurance companies just offer the packages then just charge an administative fee for the package your employer chose for you. So when you say UHC sucks it is really your employer who said NO to your surgery. So plead your case to your employer and see if they will make the exception they will be the ones paying the biggest portion for surgery. MikeInFlorida I would say when you submitted all the documentation, UHC contacted the account manager for AT&T who then contacts AT&T Corporate, presenting all your documentation, to get them to go ahead and authorize the approval. In otherwords UHC went to bat for you, but I understand they still suck. I continuously hear it from the customer's I have to deal with, it is always our fault, because their employer chose the plan they are under. That is my two cents, thanks for reading.

I would like to add my two cents as I work for a company that provides prescription benefits to employers for their employees. First my company' date=' just like UHC offers "your" employer various plans, some of which may or may not have WLS benefits, (my employer different coverage for different medications). Companies such as AT&T are self insured which means they choose an insurance company offering the best administative price for an insurance package they have selected. UHC offered various packages to AT&T who in turn selects what type of plan they want to offer their employees, the plan that they will pay for the WLS or the plan that doesn't. (One will cost more then other won't). Thus, UHC doesn't make the decision whether you can have WLS your employer did. UHC then administers AT&T's account and they have to abide by the rules of the plan selected by your employer. Now if you want to blame UHC then blame them for offering the "no WLS benefit package plan" and then you can blame the next insurance company for the same exclusion because your employer will change to an insurance company that does have that exclusion as it probably will be cheater. So who made the decision regarding WLS it was your EMPLOYER, obvious they don't care if you end up in the hospital with a major stroke, ambutation because of diabetes, or a major heart attack even though it will be costing them (remember they are self insured they foot what you don't have to pay the doctors, labs, and hospital). Insurance companies just offer the packages then just charge an administative fee for the package your employer chose for you. So when you say UHC sucks it is really your employer who said NO to your surgery. So plead your case to your employer and see if they will make the exception they will be the ones paying the biggest portion for surgery. MikeInFlorida I would say when you submitted all the documentation, UHC contacted the account manager for AT&T who then contacts AT&T Corporate, presenting all your documentation, to get them to go ahead and authorize the approval. In otherwords UHC went to bat for you, but I understand they still suck. I continuously hear it from the customer's I have to deal with, it is always our fault, because their employer chose the plan they are under. That is my two cents, thanks for reading.[/quote']

I too have UHC as my primary thru Walmart. Our policy does not cover wls either. Fortunately, my DH works for FedEx and we have awesome insurance thru Cigna. When I was perusing wls years ago and was so discouraged, someone finally explained it --where I could understand--why these corporations choose to exclude wls from their insurance. Walmart (and other companies) typically have a big turnover. An associate could begin employment, wait out the waiting period, have the expensive surgery, then quit. It doesn't matter if you have comorbidities that they are going to have to treat for the rest of your life. I think they should have a rider tho, that you have to work for say, two years before they'll cover. But who am I?

I too have UHC as my primary thru Walmart. Our policy does not cover wls either. Fortunately, my DH works for FedEx and we have awesome insurance thru Cigna. When I was perusing wls years ago and was so discouraged, someone finally explained it --where I could understand--why these corporations choose to exclude wls from their insurance. Walmart (and other companies) typically have a big turnover. An associate could begin employment, wait out the waiting period, have the expensive surgery, then quit. It doesn't matter if you have comorbidities that they are going to have to treat for the rest of your life. I think they should have a rider tho, that you have to work for say, two years before they'll cover. But who am I?

You have a great idea about the length of employment before WLS is covered. I am fortunate because my company is quite aware of the problems with weight so the eight years I have worked for them it has always been in the policy, and I will say our turnover is apx 50% per year. Get this though,5/31/13 I dropped my company's insurance as the premiums almost doubled for the PPO plan, so switched over to my Medicare and medicare approves lapband and RNY and I only had to do a three month weight management, which I actually started before I switched. But my employer not only paid for my lapband they also had to pay to have it removed because it failed. I think I only paid $350.00 to have it put in and didn't have to pay anything to have it removed as had met my deductible and maxmium out of pocket. During my eight years I also had Cigna, BCBS, and the last two years Aetna. I don't complain because I know who makes the decisions and I really feel for the Customer Reps that have to take the rude, insulting, angry calls from the employees of these companies. In fact I had such a call this afternoon.

You have a great idea about the length of employment before WLS is covered. I am fortunate because my company is quite aware of the problems with weight so the eight years I have worked for them it has always been in the policy' date=' and I will say our turnover is apx 50% per year. Get this though,5/31/13 I dropped my company's insurance as the premiums almost doubled for the PPO plan, so switched over to my Medicare and medicare approves lapband and RNY and I only had to do a three month weight management, which I actually started before I switched. But my employer not only paid for my lapband they also had to pay to have it removed because it failed. I think I only paid 350.00 to have it put in and didn't have to pay anything to have it removed as had met my deductible and maxmium out of pocket. During my eight years I also had Cigna, BCBS, and the last two years Aetna. I don't complain because I know who makes the decisions and I really feel for the Customer Reps that have to take the rude, insulting, angry calls from the employees of these companies. In fact I had such a call this afternoon.[/quote']

I know what you mean, as I said in my earlier posts, I worked for UHC. And we only dealt with small groups. None of the small groups we serviced covered wls. And I felt so bad having to tell our customers that wls was not coverd and wouldn't be under the plan they were on. I Always let them know that it was their employer that chose the plan coverage and that they should talk to them.

I have UHC too with at&t as my employer. UHC sucks. They declined me 3 years ago because I couldn't prove 5 years of Morbid Obesity. I'm one of those 55 BMI=er's that never went to the doc' date=' so I don't have a recorded weight for 5 consecutive years. Fast forward 3 years later and 60 lbs heavier, they finally approved me. This time I sent them multiple letters from myself and family. I also included photos with my shirt off so they could get a realistic idea of me. I also included photos of the scale. I'm 2 weeks out and feeling great. Down almost 30 lbs since my initial visit. As many said, keep trying.[/quote']

Can I ask what the name of your plan is under UHC that covered wls? I have uhc with at&t as my employer (well, my mom's employer, but i'm covered under her) as well, and the plan I'm on, all wls is specifically excluded. We're looking to change plans once open enrollment rolls around in Nov to a plan that will cover it, but not sure which one:/ You're the first person I've come across that is a fellow at&t employee under uhc, so I had just had to ask your experience! Lol

Congrats on your success with your surgery!

UHC PPO

I am so confused about the plan requirements. Yes, gastric bypass is covered. BUT, you have to have 1) BMI 35 < with commodities, or 2) BMI +40. Now were my confusion comes in is about the 6 month diet. Has anyone gotten an approval without being required to do the diet? I'm concerned because i don't want to be put in this tug of war where i start the diet, loose weight and then the insurance (or surgeon) denies me because i no longer meet the requirements. I have been doing the yo-yo weight loss for years and it almost always comes back. Im tired of being so big.

My stats are, 5'3", 282 lbs, 49.9 BMI. I have always been big/heavy and it has gotten out of control. My mother died at 47 from diabetic complications and had HBP and heart disease. My father is diabetic, hypertensive & high cholesterol. I have been treated for weight loss with pills, thyroid (post pardum) and pre-diabetes with in the 12-18 months. My consult is 11/26/13. I am so anxious about what to expect.

My plan is effective January 1.

I believe most insurances have open enrollment in November and some in January. If you can upgrade your plan to one that covers it for a year. Good luck to you!

UHC PPO

I am so confused about the plan requirements. Yes, gastric bypass is covered. BUT, you have to have 1) BMI 35 < with commodities, or 2) BMI +40. Now were my confusion comes in is about the 6 month diet. Has anyone gotten an approval without being required to do the diet? I'm concerned because i don't want to be put in this tug of war where i start the diet, loose weight and then the insurance (or surgeon) denies me because i no longer meet the requirements. I have been doing the yo-yo weight loss for years and it almost always comes back. Im tired of being so big.

My stats are, 5'3", 282 lbs, 49.9 BMI. I have always been big/heavy and it has gotten out of control. My mother died at 47 from diabetic complications and had HBP and heart disease. My father is diabetic, hypertensive & high cholesterol. I have been treated for weight loss with pills, thyroid (post pardum) and pre-diabetes with in the 12-18 months. My consult is 11/26/13. I am so anxious about what to expect.

My plan is effective January 1.

UHC PPO

I am so confused about the plan requirements. Yes, gastric bypass is covered. BUT, you have to have 1) BMI 35 < with commodities, or 2) BMI +40. Now were my confusion comes in is about the 6 month diet. Has anyone gotten an approval without being required to do the diet? I'm concerned because i don't want to be put in this tug of war where i start the diet, loose weight and then the insurance (or surgeon) denies me because i no longer meet the requirements. I have been doing the yo-yo weight loss for years and it almost always comes back. Im tired of being so big.

My stats are, 5'3", 282 lbs, 49.9 BMI. I have always been big/heavy and it has gotten out of control. My mother died at 47 from diabetic complications and had HBP and heart disease. My father is diabetic, hypertensive & high cholesterol. I have been treated for weight loss with pills, thyroid (post pardum) and pre-diabetes with in the 12-18 months. My consult is 11/26/13. I am so anxious about what to expect.

My plan is effective January 1.

Call your plan's 800 number to find out the exact approval qualifications. Even if it's UHC, they seem to all be different depending on employer. I went though the 6 month thing because my surgeon said I had to. 6 months later I got denied because all they wanted was proof of 35+ BMI for 5 years. I couldn't prove it because I don't go to doctors. Fast forward 3 years, and I go approved, had the surgery, and am down 70 pounds in 3 months. There was no 6 month diet or anything like that for me. Dr. Teixeira in Orlando was my surgeon.

I just used the open enrollment period to upgrade my coverage. I was covered by this plan before but my employer didn't explain the rules for keeping it. I am sure if i needed to i could dig up 5 years worth of medical records but i am pretty sure i wont need to. the only thing i'm worried about is the 6 month diet and/or denial. I didn't put in my initial post but i also now have arthritis and have suffered from sciatica and degenerative disk/joint disease for years. I'm hoping with the documentation from those issues, my physician referral and the surgeons recommendation I can be approved without any pre-requirements.

Thanks for the feedback.

after getting denied the first time, I realized that most surgeons have a bunch of things that you need to get done before they send it to insurance. If you do your own legwork and get the specifics from your provider, you can dictate to your doctor what is and what is not necessary. Standard clearances are: cardiac (stress test), sleep apnea study, psychologist, nutritionist consult, blood work, gallbladder sonogram.....those you can't get around. Ideally, they want you to lose some weight before the surgery because it makes it easier for them to do the surgery. I only lost 4 pounds from my initial consult. Your insurance approval will be based on your starting weight, not how much you lose before surgery...trust me, the doc wants to collect his money, and won't sabotage your approval. They should have experts in his office to get it approved. I believe the 6 month thing is something they throw in there because some insurance companies require it. Mine, UHC, didn't. I sent them an email to request approval requirements, they replied with the answer, and I brought it in to the doctors office. My initial consultation was in May, I had my surgery August 16. They do want you to start a liquid diet 2-4 weeks prior to the surgery because this will be the diet you will be on for 4-6 weeks post-op. Mostly Protein shakes.

One other thing. I'm not sure if this helped, but I took photos of myself and also wrote a letter to the insurance company basically begging them to approve it. Hope this info helps.

Hello everyone, I'm new here.

As of Jan 1 2014 I will have my UHC choice plus benefits. I have called TWICE to ask specifically what the requirements are. I was told 1) 40+ BMI OR 2) 35 plus comp.. I asked about 6 month monitored diet and they said no, not required. I have searched high and low for the actual written requirements and cant find anything. I have waited 5 yrs to have the chance to have this surgery....has ANYONE had UHC and was NOT required 6 months or 5 yr documentation?

Thanks!

I also had UHC, with a "bariatric" exclusion.

I took money out of my IRA to self-pay for surgery; glad I did.

But...be VERY careful. My doctor billed "other" charges to insurance; they covered most of them( because they were coded as "medical" rather than "bariatric". That would be fine IF I got a refund, but he kept it ALL! Now, I'm having to fight with insurance and the doctor to keep him from being paid twice!! After charging me $22K for the surgery, th ey billed ANOTHER $30K to insurance...which makes my surgery (billed) amount around $55K!!! What a scam!

And...they get away with it, because you can't do an insurance appeal, because it was not denied. They code it as if you had all these add-on procedures ("discovered" at time of surgery--NOT!) so insurance will pay, but they will keep it ALL!!! Makes sure it's VERY CLEAR what (if any) is self-pay and/or what is insurance coverage; otherwise, they will bill both and make extra money off you. It is "the norm" in bariatric surgery practices nation-wide.