Hi everyone!

I went to my first appointment today and found out my insurance requirements (I have United Healthcare Choice Plus) -- 40 BMI or 35-39 BMI with two comorbidities, and 5 year health history with 40 BMI. Today when I weighed I was at 40.5, and I know I was not that high through the last 5 years, although I am sure I was above 35.

The only comorbidity I have is hypertension although they told me the insurance might not count it b/c I am not on meds. I am scheduled for a sleep study which might diagnose me with sleep apnea.

Anyone think I have any chance of getting my insurance to approve? Thanks!

My surgeon's office just called me they got verbal approval on Friday and we set my surgery up for 4/10.:party:

If you have any joint problems (knee problems, osteoarthritis, etc.) that have been documented, those will help. My BMI was over 40 for YEARS and I have only one comorbidit (knee surgery) and none of the docs in my state (Tennessee) would approve the surgery; so, I finally became a self pay and went to Mexico for mine... Best decision I ever made for myself! Good luck!

I go for my psyc exam Monday 06152009. I have to have my Thyroid out before my PCP will write the letter recommending me for surgery. I'm taking the meds to get my Thyroid under control so they can schedule my surgery. Should be able to have the Thyroid surgery in August. I'm trying to push to get the surgery before the end of the year due to a high deductable.. 2300 per year. ANY ATT United Health Care out there?

I also have United Health Care.. 40 BMI and hypertension... I have hyperthyroid (taking meds) and acid reflux (taking meds). I have to have my thyroid out before my PCP will recommend me for surgery. My thyroid surgery is scheduled for August. I have already been to the nutritionalist, physical therapist. I have my psyc appointment on Monday. Lets keep in touch to see if we get approved. We might learn from each other... I have UHC through ATT and I'm from Bham Al.

Has any one had any issues with United Healthcare not wanting to pay for the lap band? Hubby just had the surgery about 2 weeks ago and today we got a letter stating that they were not going to pay for the surgery. I'm kind of freaking out because before the surgery the Dr said this wouldn't be rejected so the thought of possibly having to pay for the surgery on our own never crossed our mind! We don't even have any idea of what the surgery costs. Anyone experience anything similar?

Do you have your letter saying that they approved the surgery? Did they say what part of the bill they are not paying since there is a lot of bills with it? I wonder if someone used the wrong billing/procedure codes? I would ask for more details from UHC and then talk with all the doctors offices that deals with the billing and see what happens. Good Luck with things any questions just ask.

Chris

My BMI is 37. I was scared I would not be approved because I didn't have any major co-morbities, such as diabetes or hypertension. My doctors office submitted with co-mobities of DJD(degenerative joint desease),GERD(reflux/heartburn),mild obstructive sleep apnea,depression, and cronic back pain. I called UHC 7 days after things were sumitted and YES!!!!! Iwas approved....just found out yesterday. Waiting for psychiatrist to turn in his report stating I'm mentally stable,and that's not a problem, I passed his little test....if he only knew!!! Just kidding,seriously,but any mom of 4 boys under the age of 7,you have to admit, IS slightly mental. But after he turns in his report,we can set the date.

My BMI is 37. I was scared I would not be approved because I didn't have any major co-morbities, such as diabetes or hypertension. My doctors office submitted with co-mobities of DJD(degenerative joint desease),GERD(reflux/heartburn),mild obstructive sleep apnea,depression, and cronic back pain. I called UHC 7 days after things were sumitted and YES!!!!! Iwas approved....just found out yesterday. Waiting for psychiatrist to turn in his report stating I'm mentally stable,and that's not a problem, I passed his little test....if he only knew!!! Just kidding,seriously,but any mom of 4 boys under the age of 7,you have to admit, IS slightly mental. But after he turns in his report,we can set the date.

Cajummama you have given me hope!!!! im in the same predicament.

congrats cajunmama, i got aproved couple of weeks ago too by uhc but my surgery is not unti sep 24, it seems like a long ways but it getting here and i am servous because i have to loose 17 pound and i am afraid not do it.

good luck

Does UHC pay the bulk of the bills for a LAP-BAND®? How much could I expect to pay out of pocket? I'm sorry I'm new on my search for knowledge and I just want to make sure I take all the correct steps. :tongue:

Edited December 23, 200916 yr by samiott

Does UHC pay the bulk of the bills for a LAP-BAND®®? How much could I expect to pay out of pocket? I'm sorry I'm new on my search for knowledge and I just want to make sure I take all the correct steps. :tongue:

It depends on the type of coverage you have. I have Choice Plus and everything was covered for my surgery.

Thanks! I do have Choice Plus.

Call your insurance company and ask if WLS is covered then ask them for the exact wording of the requirements. I have choice plus as well. If it's like mine, I can help you by telling you what I did...

Call your insurance company and ask if WLS is covered then ask them for the exact wording of the requirements. I have choice plus as well. If it's like mine, I can help you by telling you what I did...

I called them but they said they can't tell me anything until my Dr sends in my paperwork. I'm sticking it in the mail to my Dr tomorrow morning. They said at first that it was not covered but then I asked about medical necessity and then they said my Dr had to send in a letter for the medical necessity which shouldn't be a problem. I have HBP, Cholesterol, BMI of 40 and I'm on Diabetic meds.

My Dr needs to look over my paperwork and let me know if he will do my surgery, then he sends my information off to UHC.

btw, I have UHC Choice plus also, did you have any problems getting it approved?

Does UHC pay the bulk of the bills for a LAP-BAND®®? How much could I expect to pay out of pocket? I'm sorry I'm new on my search for knowledge and I just want to make sure I take all the correct steps.

They paid everything after except my $1,000 max out-of-pocket. The one thing to watch for is out of network providers I had one and it took awhile to get that paid they paid part of it and that provider took that as full payment but I almost had to pay $2,000 for that one.