Anyone with United Healthcare get LB?

saravalintine · 09-27-2007, 12:00 PM

I have uhc and was wondering if Im going to get approved for the surgery.
IM 21, 270 with diabetes and High Blood pressure, My BM1 IS 43 SO i SHOULD BE A GOOD CANDIDATE. I just dont want to get turned down for the surgery, if they dont pay, I cant afford it. Anyway....
What is the predicted weight loss per month? I mean can I expsect to lose 50lbs in 6 months? Thanks guys!!!:help::think

Add me on myspace:
MySpace

Lisa99 · 09-27-2007, 12:07 PM

Husband has UHC. His BMI was over 40 and he had one co-morbidity. He was approved and had surgery about 18 months ago. I know some UHC plans don't cover WLS, depends on the company you work for and the agreement they have with UHC.

short1 · 09-27-2007, 01:37 PM

I have UHC and they paid 90%. My Dr. said 1-2 pounds a week is an average weight loss. Good luck!
JP

GayleTX · 09-27-2007, 01:45 PM

I attended 2 seminars by different doctors....both said UHC was the easiest ins co to get approval from.

**Wheetsin** · 09-27-2007, 01:53 PM

Let's clarify something that may be adding unnecessarily to your confusion. When you say that you have UHC, that just means that UHC is your carrier. It has nothing to do with your coverage. As a company, UHC will offer several different coverage plans - kind of like the grocery store carries several different types of groceries.

Some UHC plans exclude WLS. Others cover it at 100%. And between those two extremes there are a LOT of options. My employer offers something like 9 different UHC plans (my band was covered 100% with a $20 copay). My requirements were BMI over 40, or 35+ with 2+ comorbidities. Another person here at my work has a different UHC plan and he is required to do a 6 month diet.

What you need to do is find out which plan you have, and get the SPD (Summary Plan Description) for it. The SPD will detail what is covered and excluded. If WLS is excluded, it will be in there. This is assuming exclusion isn't at an employer level (I *think* employer enforced exlcusions are listed in the exclusions esction, anyway).

If all else fails, call your insurance company and ask them if it's covered, and/or what the requirements are. BUT, do not ask about "Lap Band". Lap Band is a brand name, like "Tylenol" -- not a generic term like "pain killer." You will want to ask about the procedure, not the band, which will be "adjustable gastric banding" or something similar. There's also a procedure code you could use, but I don't remember what it is. If you search here I'm sure you could find it.

Hope this helps.

saravalintine · 09-27-2007, 02:58 PM

Thanks all, you've helped greatly.

marieze · 09-27-2007, 04:18 PM

I have UHC and have the EPO. It is offered through my company. When I started by journey I called UHC and had them pull up my benefits so we were completely clear. I told them that my goal was to have Lap Band surgery and they told me that my policy covered both the band and gastric bypass.

I attended a seminar by a highly acclaimed bariatric surgeon here in Portland, Oregon, sent in my application and now, 6 weeks later am scheduled for all the pre-op stuff which will take place in 3 weeks. They told me that my UHC policy will pay at 90%. They even said the 10% is something that could be paid off in time, if necessary. I asked about the fills and they weren't sure but think that they too, are paid at 90%.

I would call immediately to UHC, have them pull your benefits and see what they say. I'm not sure who determines if there is a certain amount of weight I need to lose prior to surgery, but think I will call my insurance and see if there is anything noted.

Good Luck!

Marieze

MistyDTX · 09-27-2007, 05:17 PM

I have UHC and had a super easy time getting approved. Like the previous poster said though, each policy can be different so you need to check it out. For my approval they didn't require any of the testing alot of other bandsters have had to endure. No sleep-study, no doc supervised diet... it was soooo easy that I thought I must be missing something! But I got my approval letter, I've paid my 10% and my surgery is next week!

Good luck!

marieze · 09-27-2007, 05:42 PM

Just out of curiosity....how much did your 10% amount to? Also, do you have any idea what you will be paying for fills?

Marieze

MistyDTX · 09-27-2007, 09:44 PM

I had to pay $250 to the doctor and $1700 to the hospital. They said I will get a separate bill from the anesthesiologist after the surgery. I have NO idea what that will be! What stinks about it is that if I had UHC last year it would have been covered 100%! But my employer changed their plan for 2007...grrrr!!

ManhBill · 09-27-2007, 10:55 PM

My insurance is with Oxford which is a UHC company. They approved mine after we sent them about 50 pages of my medical records. My BMI is under 40, so I had to jump a few extra hurdles. The best way to find out, is to call the information number on your insurance ID card. They can tell you right away if WLS is covered in your plan.

Best of luck!

Bill

kygal64 · 09-27-2007, 11:14 PM

Hello....When I first started thinking about the surgery I had Atena and I knew from talking to may others that atena wouldnt not approve the surgery till you did a 6mth prgm....so I change my ins last year to UHC because everyone I knew who had them said they appove with no problem.....I went for my 1st apt in Feb with my surgon he put me thu all kinds of test and classes and in april I was told I was approved.....I had my surgery on May 21st.....I am 42 and I am diebetic..........I dont think you will have any problems getting approved........Since my surgery I have lost 54lbs.......that is n 4 months....Just remember everybody loses different.........

Good Luck and keep in touch

Glenna from Ky

:)

PrettyBrownEyez · 09-27-2007, 11:16 PM

Hi Wheetsin~ I think the two of us has the exact same plan with UHC. They covered my surgery 100%. Do you know how the handle fills? I'm due to go in the 9th and was just wondering if that will be out of pocket.

Thanks!

violeteyes37 · 09-28-2007, 07:32 AM

I have UHC and had surgery on May 30. My experience is posted in the insurance section if you feel like reading. Now after all of that happened UHC is now trying to back track and claim that the Dr never got preapproval and they are claiming that they arent going to pay for the surgery now. The Dr office keeps telling me not to worry about it because they no that all of the paper work was done before hand and that this is just the insurance companies way of stalling before having to pay a large bill but I cant help but to worry because I did sign a paper that said if for some reason my insurance doesnt pay that I will. I guess they are appealing but I havent heard anything else. I do check the myuhc website and the bill still isnt paid. :angry

Chris61 · 09-28-2007, 09:39 AM

MY wife and I have UHC PPO and we were both approved for the band with in the 30 days. The cost for us so far was $125.00 co-pay for the hosp. Have not seen the other bills yet. I hope that this helps out. When I get more information I will post it here.

Chris