Was the approval process long or expensive?

I have to do 6 months of appts prior...and there's a full list of tests and things to be done, but my insurance covers them if I stay in network. Out of pocket at this point is co-pays. Thankfully, my co-pay is zero on specialists. The biggest hurdle is your deductible, but since I've had other issues going on, we've just hit ours.

Hey, I have UHC in NYC. I was sleeved March 26. I made a post back then regarding some of the requirements that I had. I posted the link below:

Hey, I have UHC in NYC. I was sleeved March 26. I made a post back then regarding some of the requirements that I had. I posted the link below:

Thank you!!! Very good information!!!

I have to do 6 months of appts prior...and there's a full list of tests and things to be done, but my insurance covers them if I stay in network. Out of pocket at this point is co-pays. Thankfully, my co-pay is zero on specialists. The biggest hurdle is your deductible, but since I've had other issues going on, we've just hit ours.

Hopefully mine does too!! I go for my seminar on the 3rd!!

Congratulations!! You will learn so much.

Congratulations!! You will learn so much.

Thank you so much!!!

Actually each plan is different. The best way to find out is submit a pre approval with dummy date. I'm UCH and had no supervised diet requirements just medical necessity at 40+ BMI. My first appointment was Nov 28th I could have had surgery as early as Feb.

My WLS was convinced I needed the 6 mths supervised diets because other UHC patients had been denied but I insisted they submit which they did in Feb, they did and it was approved in 3 days

UHC has many plans in many states for many employers each can be different.

I do, and I was not happy with them when it came time to get approval. We (the hospital and I) asked them 3 separate times what was required to get surgery. Each time they told us all I needed was a certain BMI and 5 years of history of obesity. Then, 3 months later, the hospital submits the paperwork and UHC says no, they need me to be on a 6 month supervised WL plan. NO PREVIOUS MENTION OF THIS. So my surgery got pushed back. Ultimately the majority was covered so it's all good now, but man was I disappointed at the time!

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Actually each plan is different. The best way to find out is submit a pre approval with dummy date. I'm UCH and had no supervised diet requirements just medical necessity at 40+ BMI. My first appointment was Nov 28th I could have had surgery as early as Feb.

My WLS was convinced I needed the 6 mths supervised diets because other UHC patients had been denied but I insisted they submit which they did in Feb, they did and it was approved in 3 days

UHC has many plans in many states for many employers each can be different.

Really!!?? I'll try that!!

I do, and I was not happy with them when it came time to get approval. We (the hospital and I) asked them 3 separate times what was required to get surgery. Each time they told us all I needed was a certain BMI and 5 years of history of obesity. Then, 3 months later, the hospital submits the paperwork and UHC says no, they need me to be on a 6 month supervised WL plan. NO PREVIOUS MENTION OF THIS. So my surgery got pushed back. Ultimately the majority was covered so it's all good now, but man was I disappointed at the time!

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Oh wow, yes I'm finding each time I call I get different answers...smh!! Thank you for the heads up!

I have UHC but in the Pacific northwest region. I was required 3 months of supervised dr visits , psych eveal, labs, EKG, and attend the surgical groups class. Once I attended the classes they pretty much knew I would be approved . Once the actual request was sent I had an answer in 2 days.

I have UHC but in the Pacific northwest region. I was required 3 months of supervised dr visits , psych eveal, labs, EKG, and attend the surgical groups class. Once I attended the classes they pretty much knew I would be approved . Once the actual request was sent I had an answer in 2 days.

I hope mine goes that quickly!!

I also have UHC and found out today that WLS is excluded from our company policy. I contacted the clinic my GP suggested, they are the ones who contacted the insurance company. (They don't see patients first, they contact the insurance first before even seeing you. Is that normal?). When I asked about possibly appealing the decision (since my BMI is 48 and I have comorbidities) they said their experience is that when there is an exclusion, the insurance won't pay period and the only option I have is the cash option which they quoted me 16-18K for a sleeve, 22-24K for bypass.

I guess I'm naturally suspicious when 'things don't make sense', and I'm wondering if this clinic deliberately didn't want to appeal because they would rather have patients who don't have that exclusion on their policy or was he correct in saying if there is that exclusion, no way the insurance will pay?? Should I try again but with a larger hospital in my area (Houston) like Hermann Memorial or Methodist who have special bariatric programs rather than a specialized clinic like the one I contacted?

Love to hear thoughts about this since it's all new to me and I'm trying to get the help I need.

10 minutes ago, BDutchess said:

I also have UHC and found out today that WLS is excluded from our company policy. I contacted the clinic my GP suggested, they are the ones who contacted the insurance company. (They don't see patients first, they contact the insurance first before even seeing you. Is that normal?). When I asked about possibly appealing the decision (since my BMI is 48 and I have comorbidities) they said their experience is that when there is an exclusion, the insurance won't pay period and the only option I have is the cash option which they quoted me 16-18K for a sleeve, 22-24K for bypass.

I guess I'm naturally suspicious when 'things don't make sense', and I'm wondering if this clinic deliberately didn't want to appeal because they would rather have patients who don't have that exclusion on their policy or was he correct in saying if there is that exclusion, no way the insurance will pay?? Should I try again but with a larger hospital in my area (Houston) like Hermann Memorial or Methodist who have special bariatric programs rather than a specialized clinic like the one I contacted?

Love to hear thoughts about this since it's all new to me and I'm trying to get the help I need.

From what I've learned that's accurate that they wouldn't cover anything because the company decided not to pay for the rider. I have heard of people talking to whoever is in charge of your benefits at your workplace and seeing if they can get the rider added the following year in January or whenever your benefits renew. They also say it's a fight to get it. As farvas cash pay a lot of people are going to Tijuana to get theirs and having great success. Hope this helps!

For me, yes, they did check to make sure I'd be covered before setting up appointments. It was a fast process, but I was happy to know before starting the journey. Now I'm wrapping the last of my appts/needs...started Feb/surg. early Aug. A lot of hoops to jump through.