They are cut and dry. BMI = or > 35 with 2 preexisting conditions or BMI = or > 45 is approved. If denied have doc resubmit.

United health care approved me within 24 hrs of my letter being submitted. It was a breeze. The whole process from first phone call to surgeon to surgery date only took me about a month. I was truly blessed.

Keep in mind it all depends on what policy you have, not just the carrier. I have United Healthcare and the version my husband's employer purchased has a strict requirement of 40 BMI with no exceptions for co-morbidities. Skin of my teeth on that one. So glad all that's behind me!

I also have UHC. Fortunately for me, my husband's employer choice of requirements was rather lax. My only requirements are be over 18, bmi over 40, and bariatric center of excellence. My surgeon can be either in or out of network. I can only have one bariatric surgery per lifetime and I get 10000 for travel and lodging if need be. Luckily I live 5 miles from the surgeon's office. I also don't have to do the 6 months of nurse counseling sessions thru optum . Good luck on your weight loss journeys.

Edited March 9, 201412 yr by jtickle

I hope I'm on the last leg of my approval - when I got my inital communication in the secure message center telling me who my assigned UHC nurse was and it laid out all of the requirements - they told me I didn't need the 6 months medically supervised weight loss, then after the first call with my nurse she tells me that was wrong and I do need it - so here I am 6 months later hopefully in July I'll have approval.

Everything was going so smooth up to the point where she told me I needed that - the worse part was I had been going through a supervised program with my doctor we just didn't check in every month for 6 months straight (missed it by 15 days).

My plan excludes weight loss surgery, however, I see many people who have run into this same thing. What steps do I need to take to sort of move forward so I can get the over and done with? Paperwork? Calls? Anyone have a step by step guide on this?

Most of the time when a plan excludes weight loss surgery nothing can be done. There usually isn't anyway around it.

Most of the time when a plan excludes weight loss surgery nothing can be done. There usually isn't anyway around it.

Yeah, I just ran into this with my employer. I'm a bit bummed but I know we're having open enrollment soon again so I can either switch policies or see if they change it and allow it in (which I doubt they will, but I'm going to dream).

Sadly, if the employer plan excludes it, there isn't much you can do. And, as was mentioned before, there are a million different version of United health Care. It all depends on the version your employer picks, and some plans are custom designed by an employer (especially if that employer is self insured, which means, they pay all the bills; UHC just administers....)